Basic Information
| Provider Information | |||||||||
| NPI: | 1811384282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWEN | ||||||||
| FirstName: | RANDY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 259 E ERIE ST STE 1520 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126958150 | ||||||||
| FaxNumber: | 3126953652 | ||||||||
| Practice Location | |||||||||
| Address1: | 259 E ERIE ST STE 1520 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126958150 | ||||||||
| FaxNumber: | 3126953652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2015 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 1811384282 | WI | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 35.135844 | OH | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | MD-47095 | IA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 036159824 | IL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.