Provider Demographics
NPI:1952129736
Name:MATTHEW BOWMAN LLC
Entity type:Organization
Organization Name:MATTHEW BOWMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-503-9531
Mailing Address - Street 1:1811 PHEASANT RUN DR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2870
Mailing Address - Country:US
Mailing Address - Phone:314-503-9531
Mailing Address - Fax:
Practice Address - Street 1:94 CECIL ST
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-7057
Practice Address - Country:US
Practice Address - Phone:573-317-9279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty