Healthcare Provider Details

I. General information

NPI: 1578979712
Provider Name (Legal Business Name): CASEY LOWRANCE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 OLD HICKORY BLVD
HERMITAGE TN
37076
US

IV. Provider business mailing address

5410 OLD HICKORY BLVD
HERMITAGE TN
37076-2574
US

V. Phone/Fax

Practice location:
  • Phone: 615-883-2356
  • Fax:
Mailing address:
  • Phone: 156-883-2356
  • Fax: 865-295-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS154154
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberDO0000003174
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: