Provider Demographics
NPI:1407848203
Name:BOWER, CORY L (OD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:L
Last Name:BOWER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2946
Mailing Address - Country:US
Mailing Address - Phone:641-754-6262
Mailing Address - Fax:641-752-7420
Practice Address - Street 1:1245 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-4001
Practice Address - Country:US
Practice Address - Phone:319-286-6120
Practice Address - Fax:319-362-6098
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02148152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU77875Medicare UPIN