Provider Demographics
NPI:1093168767
Name:BOWMAN, KREED (OD)
Entity Type:Individual
Prefix:DR
First Name:KREED
Middle Name:
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 1:32 N YELLOWSTONE HWY
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5654
Mailing Address - Country:US
Mailing Address - Phone:208-346-1274
Mailing Address - Fax:
Practice Address - Street 1:76 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-2047
Practice Address - Country:US
Practice Address - Phone:208-356-4585
Practice Address - Fax:208-356-4587
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist