Provider Demographics
NPI:1265662019
Name:BOW, ELIZABETH JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JEAN
Last Name:BOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:341 W TUDOR RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6639
Mailing Address - Country:US
Mailing Address - Phone:907-770-6652
Mailing Address - Fax:907-770-3668
Practice Address - Street 1:341 W TUDOR RD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6639
Practice Address - Country:US
Practice Address - Phone:907-770-6652
Practice Address - Fax:907-770-3668
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK290152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist