Provider Demographics
NPI:1861455966
Name:LOWERY MEDICAL SURGICAL EYE CENTER PA
Entity Type:Organization
Organization Name:LOWERY MEDICAL SURGICAL EYE CENTER PA
Other - Org Name:LOWERY OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MADELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-268-1532
Mailing Address - Street 1:105 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7329
Mailing Address - Country:US
Mailing Address - Phone:501-268-1532
Mailing Address - Fax:501-268-9071
Practice Address - Street 1:105 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7329
Practice Address - Country:US
Practice Address - Phone:501-268-1532
Practice Address - Fax:501-268-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128959716Medicaid
0470820001Medicare NSC