Provider Demographics
NPI:1174546741
Name:SOWDERS, JAMES IRA (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:IRA
Last Name:SOWDERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 O ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-4116
Mailing Address - Country:US
Mailing Address - Phone:812-275-6155
Mailing Address - Fax:812-278-9405
Practice Address - Street 1:1615 O ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-4116
Practice Address - Country:US
Practice Address - Phone:812-275-6155
Practice Address - Fax:812-278-9405
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002066A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000223127OtherANTHEM
IN100166710AMedicaid
IN100166710AMedicaid
IN000000223127OtherANTHEM
IN4881170001Medicare NSC