Provider Demographics
NPI:1770684177
Name:LOWELL, DAVID S (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:LOWELL
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 1:595 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2322
Mailing Address - Country:US
Mailing Address - Phone:207-210-6700
Mailing Address - Fax:207-899-3239
Practice Address - Street 1:595 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2322
Practice Address - Country:US
Practice Address - Phone:207-210-6700
Practice Address - Fax:207-899-3239
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME534T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010418779OtherTAX ID #
ME011375OtherANTHEM
ME707783Medicare PIN
MET79596Medicare UPIN