Provider Demographics
NPI:1407070840
Name:BOWIE OPTOMETRIC GROUP
Entity Type:Organization
Organization Name:BOWIE OPTOMETRIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-262-1210
Mailing Address - Street 1:3327 SUPERIOR LN
Mailing Address - Street 2:206 &207
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1922
Mailing Address - Country:US
Mailing Address - Phone:301-262-1210
Mailing Address - Fax:301-352-3568
Practice Address - Street 1:3327 SUPERIOR LN
Practice Address - Street 2:206 &207
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1922
Practice Address - Country:US
Practice Address - Phone:301-262-1210
Practice Address - Fax:301-352-3568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD288530Medicare ID - Type Unspecified