Provider Demographics
NPI:1013196294
Name:LOWERY OPTICAL
Entity Type:Organization
Organization Name:LOWERY OPTICAL
Other - Org Name:LOWERY TRINITY EYECARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:DPO
Authorized Official - Phone:901-405-8007
Mailing Address - Street 1:7865 TRINITY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-2273
Mailing Address - Country:US
Mailing Address - Phone:901-405-8007
Mailing Address - Fax:
Practice Address - Street 1:7865 TRINITY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-2273
Practice Address - Country:US
Practice Address - Phone:901-405-8007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN121156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty