Healthcare Provider Details

I. General information

NPI: 1619308541
Provider Name (Legal Business Name): BOWMAN FAMILY EYE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 W COLLIN RAYE DR
DE QUEEN AR
71832-2502
US

IV. Provider business mailing address

1302 W COLLIN RAYE DR
DE QUEEN AR
71832-2502
US

V. Phone/Fax

Practice location:
  • Phone: 870-642-2677
  • Fax: 870-642-2777
Mailing address:
  • Phone: 870-642-2677
  • Fax: 870-642-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberD2365
License Number StateAR

VIII. Authorized Official

Name: JOHNNY L. BOWMAN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 870-845-3725