Provider Demographics
NPI:1437293743
Name:BOWERS, KIMBERLY L (OD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:L
Last Name:BOWERS
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 1:2327 TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2586
Mailing Address - Country:US
Mailing Address - Phone:919-661-2957
Mailing Address - Fax:855-898-2565
Practice Address - Street 1:2327 TIMBER DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-2586
Practice Address - Country:US
Practice Address - Phone:919-661-2957
Practice Address - Fax:855-898-2565
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1454152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC22-50376OtherUNITED HEALTH CARE
NC0905-MOtherBLUE CROSS BLUE SHIELD
NCU36818OtherAETNA HEALTH
NC0905-MOtherBLUE CROSS BLUE SHIELD
NCU36818Medicare UPIN