Provider Demographics
NPI:1245412568
Name:BOWERS, C. RICHARD JR (MD)
Entity Type:Individual
Prefix:
First Name:C.
Middle Name:RICHARD
Last Name:BOWERS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 HART RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2442
Mailing Address - Country:US
Mailing Address - Phone:859-229-3053
Mailing Address - Fax:859-278-6325
Practice Address - Street 1:715 SHAKER DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3662
Practice Address - Country:US
Practice Address - Phone:859-278-8443
Practice Address - Fax:859-278-6325
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20668207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64206683Medicaid
1352002Medicare PIN
KY64206683Medicaid