Provider Demographics
NPI:1053408344
Name:TOM SOWASH OD & ASSOCIATES
Entity type:Organization
Organization Name:TOM SOWASH OD & ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWASH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:720-570-4338
Mailing Address - Street 1:PO BOX 849764
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-9764
Mailing Address - Country:US
Mailing Address - Phone:210-524-6663
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:6555 E SOUTHERN AVE
Practice Address - Street 2:SUITE 2410
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3718
Practice Address - Country:US
Practice Address - Phone:480-985-7239
Practice Address - Fax:480-854-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5250740013Medicare NSC