Provider Demographics
NPI:1720215361
Name:LOWDERMILK, STACY L (OD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:L
Last Name:LOWDERMILK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:STIEGELBAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1346 S COUNTY ROAD 200 E
Mailing Address - Street 2:
Mailing Address - City:CENTERPOINT
Mailing Address - State:IN
Mailing Address - Zip Code:47840-8251
Mailing Address - Country:US
Mailing Address - Phone:812-249-2068
Mailing Address - Fax:
Practice Address - Street 1:422 POPLAR ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-4209
Practice Address - Country:US
Practice Address - Phone:812-242-3700
Practice Address - Fax:812-234-3565
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003587A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN859940002Medicare PIN
IN265130009Medicare PIN