Provider Demographics
NPI:1790821791
Name:BOWMAN, MELISSA ELAINE (OD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ELAINE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3827 PAXTON AVE
Mailing Address - Street 2:APT 836
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209
Mailing Address - Country:US
Mailing Address - Phone:513-254-8287
Mailing Address - Fax:
Practice Address - Street 1:11919 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249
Practice Address - Country:US
Practice Address - Phone:513-583-8970
Practice Address - Fax:513-583-9072
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH5375152W00000X
KY1602DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000337477OtherANTHEN PIN
44484OtherDAVIS VISION
OH5375OtherEYEMED
23949OtherSPECTERA
23947OtherSPECTERA
23950OtherSPECTERA
311662319FOtherHUMANA
44480OtherDAVIS VISION
23952OtherSPECTERA
9984OtherAVESIS PIN
44485OtherDAVIS VISION
44487OtherDAVIS VISION
000000337477OtherANTHEN PIN
KYU96228Medicare UPIN
OHME9346552Medicare PIN
44487OtherDAVIS VISION
OHME9346551Medicare PIN
KY0943201Medicare PIN
44485OtherDAVIS VISION
OH04202088089Medicare ID - Type UnspecifiedPCN