Provider Demographics
NPI:1629066410
Name:BOWMAN, CHRISTINA BETH (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:BETH
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 1:905 PARK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4101
Mailing Address - Country:US
Mailing Address - Phone:904-264-1206
Mailing Address - Fax:
Practice Address - Street 1:905 PARK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4101
Practice Address - Country:US
Practice Address - Phone:904-264-1206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2381606OtherUNITED HEALTHCARE
FL620874600Medicaid
FL28000OtherBLUE CROSS BLUE SHIELD FL
FL7609541OtherAETNA
FL620874600Medicaid
FLP00259365Medicare PIN
FL7609541OtherAETNA
FL28000ZMedicare PIN