Individual
PHILLIP PATRICK FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2100 E HIGHLAND DR STE 100, JONESBORO, AR 72401-5144
(870) 972-6040
Mailing address
5501 S OLIVE ST, PINE BLUFF, AR 71603-7607
(870) 761-4761
(870) 761-4761
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2539
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152051722
—
AR
01
—
318407004
MISSOURI MEDICAID
MO
01
—
P00073866
RAILROAD MEDICARE
AR
Enumeration date
07/28/2006
Last updated
07/05/2023
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