Provider Demographics
NPI:1457365173
Name:BOWEN, LISA CAROL (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:CAROL
Last Name:BOWEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2570 NORTHSHORE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-4217
Practice Address - Country:US
Practice Address - Phone:972-539-3900
Practice Address - Fax:972-539-7333
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5378TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
611306Medicare ID - Type Unspecified
U66920Medicare UPIN