Healthcare Provider Details

I. General information

NPI: 1952129736
Provider Name (Legal Business Name): MATTHEW BOWMAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
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 Number
License Number State

VIII. Authorized Official

Name: MATTHEW J BOWMAN
Title or Position: OWNER
Credential: OD
Phone: 314-503-9531