MEDICARE: DR. STEVEN D. BOWSER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT002606	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235443839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN D. BOWSER O.D.

Provider Business Mailing Address
First Line	:	4022 WATKINS GLEN DR
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-5494
Country	:	US
Telephone Number	:	678-977-2196
Fax Number	:

Provider Business Practice Location Address
First Line	:	4280 E WEST CONNECTOR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-4804
Country	:	US
Telephone Number	:	770-435-4457
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2010
Last Update Date	:	01/21/2016

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