Healthcare Provider Details

I. General information

NPI: 1164688339
Provider Name (Legal Business Name): LYNN ANN LOWELL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 42ND ST
NEW YORK NY
10036-8005
US

IV. Provider business mailing address

6308 TIMBERWOLFE LN
FORT WORTH TX
76135-5220
US

V. Phone/Fax

Practice location:
  • Phone: 212-938-5824
  • Fax:
Mailing address:
  • Phone: 817-371-3809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number56 007334
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: