Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1053423699 |
---|---|
Provider Name | James Richard Bowen JR. |
First Address | Melbourne, FL 32936-1216 |
Second Address | Orlando, FL 32803-3280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 28/06/2021 |