Provider Demographics
NPI:1508192386
Name:BOWMAN, SHAYNA L (OD)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:L
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6117 OOLTEWAH GEORGETOWN RD STE 109
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5611
Mailing Address - Country:US
Mailing Address - Phone:423-238-3290
Mailing Address - Fax:423-238-3439
Practice Address - Street 1:6117 OOLTEWAH GEORGETOWN RD STE 109
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-5611
Practice Address - Country:US
Practice Address - Phone:423-238-3290
Practice Address - Fax:423-238-3439
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003733A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist