Provider Demographics
NPI:1689453540
Name:ROWE, LISA GAYLE (ABOC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAYLE
Last Name:ROWE
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 IVY LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-1947
Mailing Address - Country:US
Mailing Address - Phone:903-331-9527
Mailing Address - Fax:903-593-7967
Practice Address - Street 1:3820 HWY 64 W
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75704-6924
Practice Address - Country:US
Practice Address - Phone:903-593-7870
Practice Address - Fax:903-593-7967
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician