Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1255DT | KY |
NPI | 1003809849 |
---|---|
Provider Name | Dr. Lowell Charles Ware |
First Address | Bowling Green, KY 42101-4938 |
Second Address | Bowling Green, KY 42101-4969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 20/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
77012557 | (05) | KY |
U41351 | (02) |