Provider Demographics
NPI:1487645982
Name:BOWSER, SCOTT ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:BOWSER
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 1:100 N PEACHTREE PKWY
Mailing Address - Street 2:PEACHTREE CITY EYE CENTER SUITE 1
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1744
Mailing Address - Country:US
Mailing Address - Phone:770-487-8900
Mailing Address - Fax:
Practice Address - Street 1:100 N PEACHTREE PKWY
Practice Address - Street 2:PEACHTREE CITY EYE CENTER SUITE 1
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1744
Practice Address - Country:US
Practice Address - Phone:770-487-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU22201Medicare UPIN
GA581601993Medicare ID - Type Unspecified