Provider Demographics
NPI:1972506020
Name:BOWIE, HOLLY E (OD)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:E
Last Name:BOWIE
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 1:3430 BIENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5732
Mailing Address - Country:US
Mailing Address - Phone:228-875-6658
Mailing Address - Fax:228-875-0809
Practice Address - Street 1:3430 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5732
Practice Address - Country:US
Practice Address - Phone:228-875-6658
Practice Address - Fax:228-875-0809
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS705152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI2398OtherMEDICARE RAILROAD
MS09015682Medicaid
CI2398OtherMEDICARE RAILROAD
0746400002Medicare NSC
MSC00912Medicare ID - Type UnspecifiedGROUP NUMBER
MS410000293Medicare ID - Type Unspecified