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General NPI Number Information
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NPI Number | 1164418273
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Entity Type | Individual
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Provider Name | MICHAEL JAMES BOWKER OD
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Gender | Male
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 122 N OAK PARK AVE
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City | OAK PARK
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State | IL
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Zip | 60301-1304
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Country | US
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Telephone | 708-524-2020
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Fax | 708-524-2022
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Provider Business Mailing Address
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Address Line | 960 S OAK PARK AVE
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City | OAK PARK
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State | IL
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Zip | 60304-1923
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Country | US
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Telephone | 708-848-1717
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Fax | 708-848-2396
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0466944
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License Number State | IL
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