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General NPI Number Information
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NPI Number | 1508144403
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Entity Type | Organization
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Legal Business Name | KATHY L. BOWEN, OD LLC
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 1300 EDWARDS FERRY RD NE
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City | LEESBURG
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State | VA
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Zip | 20176-3355
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Country | US
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Telephone | 703-669-5064
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Fax |
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Provider Business Mailing Address
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Address Line | 21540 SHEFFIELD CT
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City | ASHBURN
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State | VA
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Zip | 20147-4564
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Country | US
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Telephone | 703-726-3923
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHY BOWEN
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Credential | OD
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Telephone | 703-726-3923
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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 | 0618001553
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License Number State | VA
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