Provider Demographics
NPI:1134333693
Name:MOWBRAY, LORI LOUISE (OD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:LOUISE
Last Name:MOWBRAY
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1650 W 82ND ST
Mailing Address - Street 2:#800
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1419
Mailing Address - Country:US
Mailing Address - Phone:952-844-0844
Mailing Address - Fax:952-844-0810
Practice Address - Street 1:1650 W 82ND ST
Practice Address - Street 2:#800
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1419
Practice Address - Country:US
Practice Address - Phone:952-844-0844
Practice Address - Fax:952-844-0810
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2010-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN1832152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy