Provider Demographics
NPI:1659313286
Name:LOWELL VISION CENTER, P.C.
Entity Type:Organization
Organization Name:LOWELL VISION CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:DURKEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-897-2020
Mailing Address - Street 1:2186 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-8637
Mailing Address - Country:US
Mailing Address - Phone:616-897-2020
Mailing Address - Fax:616-897-2041
Practice Address - Street 1:2186 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-8637
Practice Address - Country:US
Practice Address - Phone:616-897-2020
Practice Address - Fax:616-897-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002803152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0299500001Medicare NSC