Provider Demographics
NPI:1871796193
Name:LOWELL C. WARE EYECARE, INC.
Entity type:Organization
Organization Name:LOWELL C. WARE EYECARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-781-2220
Mailing Address - Street 1:952 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4938
Mailing Address - Country:US
Mailing Address - Phone:270-781-2220
Mailing Address - Fax:270-781-2155
Practice Address - Street 1:952 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4938
Practice Address - Country:US
Practice Address - Phone:270-781-2220
Practice Address - Fax:270-781-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1255 DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77012557Medicaid
KY77012557Medicaid