Healthcare Provider Details

I. General information

NPI: 1982675377
Provider Name (Legal Business Name): BOWEN FAMILY EYECARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TRINITY ST
ABBEVILLE SC
29620-2130
US

IV. Provider business mailing address

100 TRINITY ST
ABBEVILLE SC
29620-2130
US

V. Phone/Fax

Practice location:
  • Phone: 864-366-2020
  • Fax: 864-366-5108
Mailing address:
  • Phone: 864-366-2020
  • Fax: 864-366-5108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1084
License Number StateSC

VIII. Authorized Official

Name: DR. LELAND H BOWEN
Title or Position: PRESIDENT
Credential: OD
Phone: 864-366-2020