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General NPI Number Information
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NPI Number | 1760677058
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Entity Type | Organization
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Legal Business Name | LOWELL OPTOMETRIC CENTER
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 303 E MAIN ST
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City | LOWELL
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State | IN
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Zip | 46356-1711
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Country | US
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Telephone | 219-696-7191
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Fax | 219-696-8551
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Provider Business Mailing Address
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Address Line | 303 E MAIN ST
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City | LOWELL
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State | IN
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Zip | 46356-1711
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Country | US
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Telephone | 219-696-7191
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Fax | 219-696-8551
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANDRA J WHITELEY
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Credential | O.D.
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Telephone | 219-696-7191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 18002511B
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License Number State | IN
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