Provider Demographics
NPI:1487980983
Name:BRETT P BOWMAN O D ASSOCIATES P S
Entity type:Organization
Organization Name:BRETT P BOWMAN O D ASSOCIATES P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-544-4810
Mailing Address - Street 1:1101 BRYAN AVE
Mailing Address - Street 2:STE. A-1
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4401
Mailing Address - Country:US
Mailing Address - Phone:714-544-4810
Mailing Address - Fax:714-368-9154
Practice Address - Street 1:1101 BRYAN AVE
Practice Address - Street 2:STE. A-1
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4401
Practice Address - Country:US
Practice Address - Phone:714-544-4810
Practice Address - Fax:714-368-9154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10289T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP10289Medicare PIN
CASD0102890Medicare PIN