Provider Demographics
NPI:1316181621
Name:BOWEN, GARY B (GARY BOWEN)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:B
Last Name:BOWEN
Suffix:
Gender:M
Credentials:GARY BOWEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3526
Mailing Address - Country:US
Mailing Address - Phone:828-698-0614
Mailing Address - Fax:828-693-6986
Practice Address - Street 1:706 FLEMING ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3526
Practice Address - Country:US
Practice Address - Phone:828-698-0614
Practice Address - Fax:828-693-6986
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1112156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5874100001Medicare NSC