Provider Demographics
NPI:1629248638
Name:BARRY V. BOWLES, O.D.,P.C.
Entity Type:Organization
Organization Name:BARRY V. BOWLES, O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:V
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-628-4401
Mailing Address - Street 1:PO BOX 1020
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-1020
Mailing Address - Country:US
Mailing Address - Phone:816-628-4401
Mailing Address - Fax:816-628-3392
Practice Address - Street 1:211 S PLATTE CLAY WAY
Practice Address - Street 2:SUITE A
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-7592
Practice Address - Country:US
Practice Address - Phone:816-628-4401
Practice Address - Fax:816-628-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO312204407Medicaid
MO312204407Medicaid
MODC6610Medicare PIN
MO5929460001Medicare NSC
S160000Medicare PIN