Provider Demographics
NPI:1598771768
Name:BOWLING, ERNEST LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:LEE
Last Name:BOWLING
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:PO BOX 764
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35983-0764
Mailing Address - Country:US
Mailing Address - Phone:256-295-2632
Mailing Address - Fax:
Practice Address - Street 1:2625 N HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-6975
Practice Address - Country:US
Practice Address - Phone:256-295-2632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-703-TA-360152W00000X
GAOPT001312152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933318Medicaid
AL1387502OtherUMWA
AL51103554OtherBCBS
AL01924OtherBCBS PLAN #601
GA00508098AMedicaid
AL51002339OtherMEDICARE TRAVELERS
ALU05596OtherVIVA HEALTH
GA00508098BMedicaid
AL117305Medicaid
AL51002339OtherBLUE CROSS BLUE SHIELD
AL117305Medicaid
AL051556971Medicare PIN
AL01924OtherBCBS PLAN #601
U05596Medicare UPIN
GA41ZCCMDMedicare PIN