Provider Demographics
NPI:1730225772
Name:MELISSA BOWMAN OD INC
Entity type:Organization
Organization Name:MELISSA BOWMAN OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-254-8287
Mailing Address - Street 1:3927 PAXTON AVE
Mailing Address - Street 2:APT 836
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209
Mailing Address - Country:US
Mailing Address - Phone:513-254-8287
Mailing Address - Fax:
Practice Address - Street 1:11919 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249
Practice Address - Country:US
Practice Address - Phone:513-583-8970
Practice Address - Fax:513-583-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1602DT152W00000X
OHOH5375152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
44484OtherDAVIS VISION
23947OtherSPECTERA
23949OtherSPECTERA
44485OtherDAVIS VISION
25952OtherSPECTERA
44480OtherDAVIS VISION
9984OtherAVESIS PIN
OH5375OtherEYEMED
000000337477OtherANTHEN PIN
23950OtherSPECTERA
44487OtherDAVIS VISION
23949OtherSPECTERA
23950OtherSPECTERA
KY9432Medicare ID - Type UnspecifiedGROUP
000000337477OtherANTHEN PIN
OHB04113258Medicare ID - Type UnspecifiedPROV #
44484OtherDAVIS VISION
OH5375OtherEYEMED
44480OtherDAVIS VISION