Provider Demographics
NPI:1437330461
Name:DRS. WOOD, LANIER & BOWMAN, PA
Entity Type:Organization
Organization Name:DRS. WOOD, LANIER & BOWMAN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-280-9000
Mailing Address - Street 1:120 A1A N STE 101
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-6609
Mailing Address - Country:US
Mailing Address - Phone:904-280-9000
Mailing Address - Fax:904-280-4448
Practice Address - Street 1:120 A1A N STE 101
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-6609
Practice Address - Country:US
Practice Address - Phone:904-280-9000
Practice Address - Fax:904-280-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI9975OtherRAILROAD MEDICARE
FL72844AOtherBLUE CROSS BLUE SHIELD
FL72844AOtherBLUE CROSS BLUE SHIELD
0651350002Medicare NSC