Provider Demographics
NPI:1194706812
Name:BOWEN, JACQUELINE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MARIE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2867 35TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-9407
Practice Address - Country:US
Practice Address - Phone:970-346-1411
Practice Address - Fax:970-346-9703
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1546152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC468448Medicare PIN
COU46091Medicare UPIN