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General NPI Number Information
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NPI Number | 1336492586
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Entity Type | Organization
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Legal Business Name | BRETT P. BOWMAN OD., PROFESSIONAL OPTOMETRY CORPORATION
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 1810 FULLERTON AVE SUITE 201
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City | CORONA
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State | CA
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Zip | 92881-3103
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Country | US
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Telephone | 951-737-0477
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Fax | 951-737-0565
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Provider Business Mailing Address
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Address Line | 1810 FULLERTON AVE SUITE 201
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City | CORONA
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State | CA
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Zip | 92881-3103
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Country | US
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Telephone | 951-737-0477
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Fax | 951-737-0565
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRETT P BOWMAN
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Credential | O.D.
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Telephone | 951-737-0477
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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 | OPT 10289T
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License Number State | CA
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