Provider Demographics
NPI:1295810489
Name:BOWLES AVENUE EYE CARE, INC
Entity type:Organization
Organization Name:BOWLES AVENUE EYE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-933-0353
Mailing Address - Street 1:11852 SHAFFER DR
Mailing Address - Street 2:BUILDING M
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-3764
Mailing Address - Country:US
Mailing Address - Phone:303-933-0353
Mailing Address - Fax:
Practice Address - Street 1:11852 SHAFFER DR
Practice Address - Street 2:BUILDING M
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-3764
Practice Address - Country:US
Practice Address - Phone:303-933-0353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1680152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5782410001Medicare NSC
COC811053Medicare PIN