Provider Demographics
NPI:1255667481
Name:BOWLING, AJA MONET (OD)
Entity Type:Individual
Prefix:DR
First Name:AJA
Middle Name:MONET
Last Name:BOWLING
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 1:7206 WILLIAMSGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-7017
Mailing Address - Country:US
Mailing Address - Phone:502-792-2096
Mailing Address - Fax:
Practice Address - Street 1:3563 SPRINGHURST BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-4144
Practice Address - Country:US
Practice Address - Phone:502-339-7323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1825DT152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist