Healthcare Provider Details

I. General information

NPI: 1548232481
Provider Name (Legal Business Name): MATTHEW JOSEPH BOWMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2006
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 CECIL ST
CAMDENTON MO
65020-7057
US

IV. Provider business mailing address

1811 PHEASANT RUN DR
MARYLAND HEIGHTS MO
63043-2870
US

V. Phone/Fax

Practice location:
  • Phone: 573-317-9279
  • Fax:
Mailing address:
  • Phone: 314-503-9531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02825
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: