Provider Demographics
NPI:1770731796
Name:ANTHONY B. LOWE, O.D., P.L.L.C.
Entity type:Organization
Organization Name:ANTHONY B. LOWE, O.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-206-8354
Mailing Address - Street 1:200 QUARRIER ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2006
Mailing Address - Country:US
Mailing Address - Phone:304-206-8354
Mailing Address - Fax:
Practice Address - Street 1:4008 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1510
Practice Address - Country:US
Practice Address - Phone:304-206-8354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1019-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001023Medicaid