Provider Demographics
NPI:1003809849
Name:WARE, LOWELL CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:CHARLES
Last Name:WARE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4938
Mailing Address - Country:US
Mailing Address - Phone:270-781-2220
Mailing Address - Fax:270-781-2155
Practice Address - Street 1:952 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4969
Practice Address - Country:US
Practice Address - Phone:270-781-2220
Practice Address - Fax:270-781-2155
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1255DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77012557Medicaid
KY77012557Medicaid
KY00229001Medicare PIN