Provider Demographics
NPI:1356438915
Name:BOWERS, MARK A
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BOWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 HIGHWAY 394 STE B
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-4133
Mailing Address - Country:US
Mailing Address - Phone:423-323-3799
Mailing Address - Fax:423-323-3752
Practice Address - Street 1:2554 HIGHWAY 394
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617
Practice Address - Country:US
Practice Address - Phone:423-323-3799
Practice Address - Fax:423-323-3752
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT2336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4087308OtherBLUE CROSS BLUE SHIELD
TN800110477OtherCIGNA
TN3945417Medicaid
TN800110477OtherCARITEN
TN800110477OtherJOHN DEERE
TN800110477OtherJOHN DEERE
U92158Medicare UPIN
TN3945417Medicare PIN