Basic Information
| Provider Information | |||||||||
| NPI: | 1407349400 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOWE FAMILY EYE CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2625 EDWARDS ST | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352101747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053175397 | ||||||||
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| Practice Location | |||||||||
| Address1: | 133 N CHALKVILLE RD | ||||||||
| Address2: | |||||||||
| City: | TRUSSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351731376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056554838 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2018 | ||||||||
| LastUpdateDate: | 06/13/2018 | ||||||||
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| AuthorizedOfficialLastName: | LOWE | ||||||||
| AuthorizedOfficialFirstName: | WHITNEY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2053175397 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | S-D85-TA-A83 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 51198317 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER |