Provider Demographics
NPI:1093002107
Name:BOWEN, HEATHER RENEE (OD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2696 CROSSROADS PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3442
Mailing Address - Country:US
Mailing Address - Phone:217-779-0882
Mailing Address - Fax:614-471-2791
Practice Address - Street 1:2696 CROSSROADS PLAZA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3442
Practice Address - Country:US
Practice Address - Phone:614-471-9005
Practice Address - Fax:614-471-2791
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-09
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6018/T2933152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH133460Medicare UPIN