Provider Demographics
NPI:1689758856
Name:LOW, LARAINE RUTH (OD)
Entity Type:Individual
Prefix:DR
First Name:LARAINE
Middle Name:RUTH
Last Name:LOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7309 STOCKTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2782
Mailing Address - Country:US
Mailing Address - Phone:916-391-0520
Mailing Address - Fax:
Practice Address - Street 1:7309 STOCKTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2782
Practice Address - Country:US
Practice Address - Phone:916-391-0520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9165T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000020Medicaid
CASD0091650Medicaid
CASD0091650Medicaid
CAT92417Medicare UPIN