Healthcare Provider Details

I. General information

NPI: 1144980830
Provider Name (Legal Business Name): FIRST IMPRESSIONS OPTOMETRIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2894 E 3RD ST STE 155
BLOOMINGTON IN
47401-5498
US

IV. Provider business mailing address

175 E HOUSTON ST
SAN ANTONIO TX
78205-2255
US

V. Phone/Fax

Practice location:
  • Phone: 812-336-2702
  • Fax: 812-336-2705
Mailing address:
  • Phone: 726-444-4078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: AJA BOWLING
Title or Position: OWNER
Credential: OD
Phone: 270-750-8384