Healthcare Provider Details

I. General information

NPI: 1275852055
Provider Name (Legal Business Name): TYLER JAMES LOWE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 ROUTE 1 BYPASS SUITE A
KITTERY ME
03904
US

IV. Provider business mailing address

99 ROUTE 1 BYPASS SUITE A
KITTERY ME
03904
US

V. Phone/Fax

Practice location:
  • Phone: 207-439-0410
  • Fax: 207-439-8353
Mailing address:
  • Phone: 207-439-0410
  • Fax: 207-439-8353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number916
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number843
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: