Provider Demographics
NPI:1083682785
Name:BOWMAN, JEFFREY D (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
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 1:1410 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-2302
Mailing Address - Country:US
Mailing Address - Phone:618-443-4373
Mailing Address - Fax:618-443-2682
Practice Address - Street 1:1410 N MARKET ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-2302
Practice Address - Country:US
Practice Address - Phone:618-443-4373
Practice Address - Fax:618-443-2682
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3081152W00000X
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
269681OtherGROUP HEALTH PLAN
UNKNOWNOtherUNBTIED HEALTHCARE
UNKNOWNOtherHEALTHLINK
UNKNOWNOtherMERCY HEALTH PLANS
MO3081OtherEYEMED
MO59572OtherHEALTHCARE USA
UNKNOWNOtherBLUE CROSS BLUE SHIELD MO
269681OtherGROUP HEALTH PLAN
UNKNOWNOtherUNBTIED HEALTHCARE