Provider Demographics
NPI:1497279442
Name:MARK A. BOWERS
Entity Type:Organization
Organization Name:MARK A. BOWERS
Other - Org Name:BLOUNTVILLE FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-323-3799
Mailing Address - Street 1:2554 HIGHWAY 394
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-4133
Mailing Address - Country:US
Mailing Address - Phone:423-323-3799
Mailing Address - Fax:423-323-3752
Practice Address - Street 1:2554 HIGHWAY 394
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617
Practice Address - Country:US
Practice Address - Phone:423-323-3799
Practice Address - Fax:423-323-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4087308OtherBLUE CROSS PROVIDER NUMBER