Provider Demographics
NPI:1508478892
Name:BOWER, ELYSE E (OD)
Entity Type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:E
Last Name:BOWER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:E
Other - Last Name:KOHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:411 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2805
Mailing Address - Country:US
Mailing Address - Phone:308-865-2760
Mailing Address - Fax:308-865-2769
Practice Address - Street 1:411 W 39TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2805
Practice Address - Country:US
Practice Address - Phone:308-865-2760
Practice Address - Fax:308-865-2769
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1517152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist