Provider Demographics
NPI:1194831123
Name:BOWERS, HARRY LEWIS III (OD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:LEWIS
Last Name:BOWERS
Suffix:III
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 1:123 PAQCOLET DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-8111
Mailing Address - Country:US
Mailing Address - Phone:864-283-9573
Mailing Address - Fax:
Practice Address - Street 1:404 MCCRAVY DR STE B
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3178
Practice Address - Country:US
Practice Address - Phone:864-585-2249
Practice Address - Fax:864-585-3040
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3038152W00000X
SC1861152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOPT003038OtherGA LICENSE
GA003191932AMedicaid
SC1861OtherSC LICENSE
SCD18612Medicaid