1053423699 NPI number — JAMES RICHARD BOWEN JR. B.C.O., B.A.D.O.

NPI Number: 1053423699
Health Care Provider/Practitioner: JAMES RICHARD BOWEN JR. B.C.O., B.A.D.O.

NPI Number : 1053423699 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053423699",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOWEN",
    "FirstName": "JAMES",
    "MiddleName": "RICHARD",
    "NamePrefix": null,
    "NameSuffix": "JR.",
    "Credential": "B.C.O., B.A.D.O.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BOWEN",
    "OtherFirstName": "RICK",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "B.C.O., B.A.D.O.",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "PO BOX 361216",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MELBOURNE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32936-1216",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "407-246-5451",
    "MailingAddressFaxNumber": "407-246-0222",
    "FirstLinePracticeLocationAddress": "10 SOUTH BUMBY AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ORLANDO",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32803-3280",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "407-493-2603",
    "PracticeLocationAddressFaxNumber": "407-246-0222",
    "EnumerationDate": "08/31/2006",
    "LastUpdateDate": "06/28/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "156FX1700X",
        "TaxonomyName": "Ocularist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}