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General NPI Number Information
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NPI Number | 1720115702
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Entity Type | Organization
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Legal Business Name | BOWERSOX VISION CENTER PSC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 403 WASHINGTON ST
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City | SHELBYVILLE
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State | KY
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Zip | 40065-1127
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Country | US
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Telephone | 502-647-3937
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Fax | 502-633-7326
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Provider Business Mailing Address
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Address Line | 403 WASHINGTON ST
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City | SHELBYVILLE
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State | KY
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Zip | 40065-1127
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Country | US
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Telephone | 502-647-3937
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Fax | 502-633-7326
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. DANIEL M BOWERSOX
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Credential | OD
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Telephone | 502-647-3937
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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 | 1301DT
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License Number State | KY
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