Provider Demographics
NPI:1740313840
Name:PURDY EYES OPTOMETRY, LLC
Entity type:Organization
Organization Name:PURDY EYES OPTOMETRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-845-9423
Mailing Address - Street 1:P.O. BOX 313
Mailing Address - Street 2:
Mailing Address - City:PURDY
Mailing Address - State:MO
Mailing Address - Zip Code:65734
Mailing Address - Country:US
Mailing Address - Phone:417-442-3020
Mailing Address - Fax:417-442-0101
Practice Address - Street 1:200 WASHINGTON STREET
Practice Address - Street 2:SUITE E
Practice Address - City:PURDY
Practice Address - State:MO
Practice Address - Zip Code:65734
Practice Address - Country:US
Practice Address - Phone:417-442-3020
Practice Address - Fax:417-442-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47632B514Medicare PIN