Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1043458185 |
---|---|
Provider Name | Mr. Gerade Eugene Bowden JR. |
First Address | Meadowbrook, PA 19046 |
Second Address | Meadowbrook, PA 19046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2009 |
Last Update Date | 28/01/2009 |