Individual
BOWEN MICHAEL MOLLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3001 BROADWAY AVE, YANKTON, SD 57078-4890
(605) 665-4600
(605) 665-4813
Mailing address
2005 ELM ST, YANKTON, SD 57078-2128
(605) 351-1363
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T615
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0100821
WELLMARK BC/BS
SD
05
—
10025365000
—
SD
01
—
29963
PROV. # FOR SPECTERA
SD
01
—
551483
PROV. # FOR NVA
SD
05
—
9203540
—
SD
Enumeration date
07/13/2006
Last updated
02/17/2009
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