Provider Demographics
NPI:1629167309
Name:LOWERY, TAMMY L (O D)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:L
Last Name:LOWERY
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:174 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-5027
Mailing Address - Country:US
Mailing Address - Phone:865-483-3616
Mailing Address - Fax:865-483-7611
Practice Address - Street 1:174 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5027
Practice Address - Country:US
Practice Address - Phone:865-483-3616
Practice Address - Fax:865-483-7611
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNV09038Medicare UPIN