Provider Demographics
NPI:1457333759
Name:LOWE, THOMAS D (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:LOWE
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 1:301 S IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-1747
Mailing Address - Country:US
Mailing Address - Phone:319-653-2371
Mailing Address - Fax:319-653-6070
Practice Address - Street 1:301 S IOWA AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1747
Practice Address - Country:US
Practice Address - Phone:319-653-2371
Practice Address - Fax:319-653-6070
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1659152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0147009Medicaid
IA14700Medicare ID - Type UnspecifiedPROVIDER NUMBER
IA0454380001Medicare NSC
IAT00890Medicare UPIN