Provider Demographics
NPI:1235443839
Name:BOWSER, STEVEN D (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:BOWSER
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 1:4022 WATKINS GLEN DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5494
Mailing Address - Country:US
Mailing Address - Phone:678-977-2196
Mailing Address - Fax:
Practice Address - Street 1:4280 E WEST CONNECTOR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-4804
Practice Address - Country:US
Practice Address - Phone:770-435-4457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002606152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003112800AMedicaid
202I419121Medicare PIN