Provider Demographics
NPI:1538139308
Name:BOWLING EYE CLINIC OD. PA.
Entity Type:Organization
Organization Name:BOWLING EYE CLINIC OD. PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-276-1993
Mailing Address - Street 1:215A W LAUCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-4647
Mailing Address - Country:US
Mailing Address - Phone:910-276-1993
Mailing Address - Fax:910-277-7364
Practice Address - Street 1:215A W LAUCHWOOD DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4647
Practice Address - Country:US
Practice Address - Phone:910-276-1993
Practice Address - Fax:910-277-7364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1177152W00000X
NC1795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890920LMedicaid
NC410046366OtherRAILROAD MEDICARD GROUP
NC890929WMedicaid
NC0555340001Medicare NSC
NC2471850Medicare PIN
NC890929WMedicaid
NC890920LMedicaid