Provider Demographics
NPI:1053464818
Name:BOWMAN, BRETT PATRICK (OD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:PATRICK
Last Name:BOWMAN
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 1:1101 BRYAN AVE
Mailing Address - Street 2:STE. A-1
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4401
Mailing Address - Country:US
Mailing Address - Phone:714-544-4810
Mailing Address - Fax:714-368-9154
Practice Address - Street 1:1101 BRYAN AVE
Practice Address - Street 2:STE. A-1
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4401
Practice Address - Country:US
Practice Address - Phone:714-544-4810
Practice Address - Fax:714-368-9154
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10289T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU60381Medicare UPIN
CAFY223ZMedicare PIN
CAU60381Medicare UPIN