Provider Demographics
NPI:1053553909
Name:FOWLER, JOHN B (LDO)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:FOWLER
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12060 HWY 17 BYP
Mailing Address - Street 2:UNIT B
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-9401
Mailing Address - Country:US
Mailing Address - Phone:843-357-2020
Mailing Address - Fax:843-357-2021
Practice Address - Street 1:12060 HWY 17 BYP
Practice Address - Street 2:UNIT B
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9401
Practice Address - Country:US
Practice Address - Phone:843-357-2020
Practice Address - Fax:843-357-2021
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCSC713156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician