Healthcare Provider Details

I. General information

NPI: 1255898292
Provider Name (Legal Business Name): KREED BOWMAN OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S SKYLINE DR STE 6
IDAHO FALLS ID
83402-3292
US

IV. Provider business mailing address

32 N YELLOWSTONE HWY
RIGBY ID
83442-5654
US

V. Phone/Fax

Practice location:
  • Phone: 208-419-5637
  • Fax:
Mailing address:
  • Phone: 208-346-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: KREED BOWMAN
Title or Position: DOCTOR
Credential: OD
Phone: 208-346-1274