Healthcare Provider Details

I. General information

NPI: 1629066410
Provider Name (Legal Business Name): CHRISTINA BETH BOWMAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 PARK AVE SUITE 100
ORANGE PARK FL
32073-4101
US

IV. Provider business mailing address

905 PARK AVE SUITE 100
ORANGE PARK FL
32073-4101
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-1206
  • Fax:
Mailing address:
  • Phone: 904-264-1206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 3780
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: