Provider Demographics
NPI:1104155035
Name:MELISSA BOWMAN OD INC
Entity type:Organization
Organization Name:MELISSA BOWMAN OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-583-8970
Mailing Address - Street 1:11919 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2019
Mailing Address - Country:US
Mailing Address - Phone:513-583-8970
Mailing Address - Fax:513-583-9072
Practice Address - Street 1:11919 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2019
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:2009-12-24
Last Update Date:2013-02-14
Deactivation Date:2013-01-08
Deactivation Code:
Reactivation Date:2013-02-14
Provider Licenses
StateLicense IDTaxonomies
OH5375152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty