Provider Demographics
NPI:1790921260
Name:BOWMAN OPTOMETRY, PA
Entity Type:Organization
Organization Name:BOWMAN OPTOMETRY, PA
Other - Org Name:BOWMAN OPTOMETRY, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-280-9000
Mailing Address - Street 1:120 A1A N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-6625
Mailing Address - Country:US
Mailing Address - Phone:904-280-9000
Mailing Address - Fax:904-280-4448
Practice Address - Street 1:120 A1A N STE 101
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-6609
Practice Address - Country:US
Practice Address - Phone:904-280-9000
Practice Address - Fax:904-280-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72844AOtherBLUE CROSS BLUE SHIELD
CI9975OtherRAILROAD MEDICARE
CI9975OtherRAILROAD MEDICARE
FL6183330001Medicare NSC