Organization
DESTIN OPHTHALMOLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRISCILLA G FOWLER MD (OWNER)
(850) 622-0757
Entity
Organization
Contact information
Practice address
7720 US HIGHWAY 98 W, SUITE 110, DESTIN, FL 32550-7230
(850) 622-0757
(850) 622-1978
Mailing address
7720 US HIGHWAY 98 W, SUITE 110, DESTIN, FL 32550-7230
(850) 622-0757
(850) 622-1978
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME90933
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IND NPI
1851398093
—
Enumeration date
09/29/2005
Last updated
08/22/2020
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