Provider Demographics
NPI:1750973764
Name:BOWEN EYE CARE CLINIC. LLC
Entity type:Organization
Organization Name:BOWEN EYE CARE CLINIC. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MEARSHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-353-5455
Mailing Address - Street 1:2867 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9407
Mailing Address - Country:US
Mailing Address - Phone:970-346-1411
Mailing Address - Fax:
Practice Address - Street 1:2108 35TH AVE STE A
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3955
Practice Address - Country:US
Practice Address - Phone:970-356-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOWEN EYE CARE CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04289731Medicaid