Individual
DR. GARY J FOWLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
120 MARCELL DR NE, SUITE A, ROCKFORD, MI 49341-1362
(616) 866-0140
(616) 866-8694
Mailing address
120 MARCELL DR NE, SUITE A, ROCKFORD, MI 49341-1362
(616) 866-0140
(616) 866-8694
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002906
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1427020023
INDIVIDUAL NPI
—
01
—
1780888081
GROUP NPI
—
05
—
5106316
—
MI
Enumeration date
02/07/2006
Last updated
09/26/2016
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