MEDICARE: BOWMAN OPTOMETRY, PA

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CI9975	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	72844A	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1790921260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOWMAN OPTOMETRY, PA

Provider Business Mailing Address
First Line	:	120 A1A N
Second Line	:	SUITE 101
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-6625
Country	:	US
Telephone Number	:	904-280-9000
Fax Number	:	904-280-4448

Provider Business Practice Location Address
First Line	:	120 A1A N STE 101
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-6609
Country	:	US
Telephone Number	:	904-280-9000
Fax Number	:	904-280-4448

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM DOUGLAS SMITH
Credential	:
Telephone Number	:	864-616-3907

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	05/01/2026

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Directions to “BOWMAN OPTOMETRY, PA ” Practice Location

Language	Start Address	Practice Location

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