Healthcare Provider Details

I. General information

NPI: 1578554523
Provider Name (Legal Business Name): JOHN PATRICK LOWERY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2043 COLLEGE WAY
FOREST GROVE OR
97116-1756
US

IV. Provider business mailing address

2043 COLLEGE WAY
FOREST GROVE OR
97116-1756
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-3139
  • Fax: 503-352-2261
Mailing address:
  • Phone: 503-352-3139
  • Fax: 503-352-2261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number3033T
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: