Healthcare Provider Details

I. General information

NPI: 1417897653
Provider Name (Legal Business Name): SAVANNAH EMILY LYNN LOWE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANNA BRADARIC LOWE OD

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3152 PEREGRINE DR NE
GRAND RAPIDS MI
49525-9723
US

IV. Provider business mailing address

457 PARIS AVE SE
GRAND RAPIDS MI
49503-5452
US

V. Phone/Fax

Practice location:
  • Phone: 616-447-1444
  • Fax:
Mailing address:
  • Phone: 616-447-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005755
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: