Provider Demographics
NPI:1538218557
Name:C SCOTT COWELL OD INC
Entity type:Organization
Organization Name:C SCOTT COWELL OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:C.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:COWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-336-2020
Mailing Address - Street 1:720 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-6425
Mailing Address - Country:US
Mailing Address - Phone:580-336-2020
Mailing Address - Fax:580-336-2333
Practice Address - Street 1:720 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-6425
Practice Address - Country:US
Practice Address - Phone:580-336-2020
Practice Address - Fax:580-336-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK906152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100762490AMedicaid
OK410036985Medicare PIN
OK700522207Medicare PIN
OK100762490AMedicaid
OK0638420001Medicare NSC