Active NPI
Brandon R. Bowen, LDO
- Optician
- Radcliff, KY
National Provider Identifier
1932744570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 110135
- Practice address
- 171 E Lincoln Trail Blvd
Radcliff, KY 40160-1253 - Phone
- (270) 351-5367
- NPI assigned
- Nov 7, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 110135 | KY | Primary |
Addresses
Primary practice location
171 E Lincoln Trail Blvd
Radcliff, KY 40160-1253
Mailing address
171 E Lincoln Trail Blvd
Radcliff, KY 40160-1253
Phone (270) 351-5367
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110135 | KY | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1573084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623283200000",
"number": "1932744570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "171 E LINCOLN TRAIL BLVD",
"city": "RADCLIFF",
"state": "KY",
"postal_code": "401601253",
"telephone_number": "270-351-5367"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "171 E LINCOLN TRAIL BLVD",
"city": "RADCLIFF",
"state": "KY",
"postal_code": "401601253",
"telephone_number": "270-351-5367"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOWEN",
"first_name": "BRANDON",
"middle_name": "R.",
"name_prefix": "Mr.",
"credential": "LDO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-11-07",
"last_updated": "2021-06-10",
"certification_date": "2021-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "KY",
"license": "110135",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Radcliff, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.