Provider Demographics
NPI:1760903520
Name:BOWMAN, TAYLOR (OD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
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 1:7 TIMOTHY RD
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-9202
Mailing Address - Country:US
Mailing Address - Phone:570-690-3523
Mailing Address - Fax:
Practice Address - Street 1:1300 E 20TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4021
Practice Address - Country:US
Practice Address - Phone:307-634-2020
Practice Address - Fax:307-635-6510
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOED003273152W00000X
WY421T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist