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General NPI Number Information
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NPI Number | 1598771768
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Entity Type | Individual
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Provider Name | ERNEST LEE BOWLING O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 04/08/2011
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Provider Practice Location Address
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Address Line | 2625 N HIGHWAY 27
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City | LA FAYETTE
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State | GA
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Zip | 30728-6975
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Country | US
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Telephone | 256-295-2632
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 764
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City | LEESBURG
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State | AL
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Zip | 35983-0764
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Country | US
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Telephone | 256-295-2632
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Fax |
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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 | S-703-TA-360
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT001312
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License Number State | GA
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