Provider Demographics
NPI:1194707455
Name:BOWERS, RALPH JEFFREY (OD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:JEFFREY
Last Name:BOWERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E IDAHO AVE
Mailing Address - Street 2:STE 28
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3242
Mailing Address - Country:US
Mailing Address - Phone:505-523-7846
Mailing Address - Fax:505-523-1262
Practice Address - Street 1:225 E IDAHO AVE
Practice Address - Street 2:STE 28
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3242
Practice Address - Country:US
Practice Address - Phone:505-523-7846
Practice Address - Fax:505-523-1262
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM227152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP0466Medicaid
NM2591160Medicare ID - Type Unspecified
NMP0466Medicaid