Provider Demographics
NPI:1346641370
Name:BOWMAN, HEATHER (OD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BOWMAN
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 1:6935 ABBOTTSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3021
Mailing Address - Country:US
Mailing Address - Phone:336-408-8357
Mailing Address - Fax:
Practice Address - Street 1:6935 ABBOTTSWOOD DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-3021
Practice Address - Country:US
Practice Address - Phone:336-408-8357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2378152W00000X
CA15334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist