| Doctor Name: | MR. JOHN B FOWLER |
| NPI Number: | 1053553909 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.D.O |
| License Number: | SC713 |
| Business Practice Address: | 12060 Hwy 17 Byp Unit B Murrells Inlet, SC - 295769401 |
| Business Phone Number: | 8433572020 |
| Business Fax Number: | 8433572021 |
| Mailing Address: | 12060 Hwy 17 Byp, Unit B MURRELLS INLET |
| State: | SC |
| Postal Code: | 295769401 |
| Phone Number: | 8433572020 |
| Fax Number: | 8433572021 |
| NPI Enumeration Date: | 03/24/2009 |
| NPI Last Update Date: | 03/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | SC713 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |