Provider Demographics
NPI:1801886502
Name:BOWMAN, EDITH G (OD)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:G
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:EDIE
Other - Middle Name:
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2001 S SHIELDS ST STE J1
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1837
Mailing Address - Country:US
Mailing Address - Phone:970-206-0100
Mailing Address - Fax:
Practice Address - Street 1:2001 S SHIELDS ST STE J1
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1837
Practice Address - Country:US
Practice Address - Phone:970-206-0100
Practice Address - Fax:970-206-0100
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74277227Medicaid
CO74277227Medicaid
COU59640Medicare UPIN
CO802289Medicare ID - Type Unspecified