Provider Demographics
NPI:1598926206
Name:BOWEN, KATHY LYNN (OD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:BOWEN
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 1:1300 EDWARDS FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3355
Mailing Address - Country:US
Mailing Address - Phone:703-669-5064
Mailing Address - Fax:
Practice Address - Street 1:1300 EDWARDS FERRY RD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3355
Practice Address - Country:US
Practice Address - Phone:703-669-5064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist