Provider Demographics
NPI:1710965181
Name:LOWRY, EVAN A (OD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:A
Last Name:LOWRY
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 1:1821 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5518
Mailing Address - Country:US
Mailing Address - Phone:724-837-5350
Mailing Address - Fax:724-837-5352
Practice Address - Street 1:1821 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5518
Practice Address - Country:US
Practice Address - Phone:724-837-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000933152WC0802X, 152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
439664OtherBLUE CROSS BLUE SHIELD
PAMA1004238Medicaid
T30444Medicare UPIN
0687760001Medicare NSC
L0439664Medicare PIN