Provider Demographics
NPI:1831502665
Name:ROWE, LAUREN (OD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ROWE
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:PO BOX 288
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-0288
Mailing Address - Country:US
Mailing Address - Phone:229-263-8851
Mailing Address - Fax:229-263-7417
Practice Address - Street 1:104 N MADISON ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-2012
Practice Address - Country:US
Practice Address - Phone:229-263-8851
Practice Address - Fax:229-263-7417
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001026152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist