Provider Demographics
NPI:1639659949
Name:BOWEN, JACOB REED (OD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:REED
Last Name:BOWEN
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 1:220 N PINE
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-2905
Mailing Address - Country:US
Mailing Address - Phone:870-234-4444
Mailing Address - Fax:870-234-0420
Practice Address - Street 1:220 N PINE
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2905
Practice Address - Country:US
Practice Address - Phone:870-234-4444
Practice Address - Fax:870-234-0420
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2053-IOD152W00000X
AR2793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist