Provider Demographics
NPI:1003075953
Name:FRANK W BOWDEN III MD FACS PA
Entity type:Organization
Organization Name:FRANK W BOWDEN III MD FACS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-296-0098
Mailing Address - Street 1:7205 BONNEVAL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7565
Mailing Address - Country:US
Mailing Address - Phone:904-296-0098
Mailing Address - Fax:904-861-3899
Practice Address - Street 1:1008 PARK AVENUE
Practice Address - Street 2:SUITE 140
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4112
Practice Address - Country:US
Practice Address - Phone:904-215-4600
Practice Address - Fax:904-296-4621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5084140001Medicare NSC