Provider Demographics
NPI:1588046734
Name:LOW, MADELEINE RAE (OD)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:RAE
Last Name:LOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11540 SANTA MONICA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7905
Mailing Address - Country:US
Mailing Address - Phone:310-473-5464
Mailing Address - Fax:310-473-2536
Practice Address - Street 1:11540 SANTA MONICA BLVD 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7905
Practice Address - Country:US
Practice Address - Phone:310-473-5464
Practice Address - Fax:310-473-2536
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15313152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist