Provider Demographics
NPI:1750373528
Name:BOWEN, JOHN S (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:BOWEN
Suffix:
Gender:M
Credentials:OD
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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 STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-8386
Practice Address - Country:US
Practice Address - Phone:972-539-3900
Practice Address - Fax:972-539-7333
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2022-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX5377TG152W00000X, 152WC0802X, 152WL0500X, 152WP0200X
TX5377152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00497EMedicare ID - Type Unspecified
TX00497EMedicare UPIN