Healthcare Provider Details

I. General information

NPI: 1194707455
Provider Name (Legal Business Name): RALPH JEFFREY BOWERS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E IDAHO AVE STE 28
LAS CRUCES NM
88005-3242
US

IV. Provider business mailing address

225 E IDAHO AVE STE 28
LAS CRUCES NM
88005-3242
US

V. Phone/Fax

Practice location:
  • Phone: 505-523-7846
  • Fax: 505-523-1262
Mailing address:
  • Phone: 505-523-7846
  • Fax: 505-523-1262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number227
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: