Provider Demographics
NPI:1508192386
Name:BOWMAN, SHAYNA L (OD)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:L
Last Name:BOWMAN
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 1:116 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-3729
Mailing Address - Country:US
Mailing Address - Phone:574-533-7345
Mailing Address - Fax:
Practice Address - Street 1:116 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-3729
Practice Address - Country:US
Practice Address - Phone:574-533-7345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003733A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist