Provider Demographics
NPI:1780971101
Name:BOWEN, AMBER (OD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:
Last Name:BOWEN
Suffix:
Gender:X
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 LEONARD ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4163
Mailing Address - Country:US
Mailing Address - Phone:616-458-7898
Mailing Address - Fax:
Practice Address - Street 1:27777 INKSTER RD STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5312
Practice Address - Country:US
Practice Address - Phone:248-436-4400
Practice Address - Fax:810-664-0220
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI4901004633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician