Provider Demographics
NPI:1356902381
Name:LOWREY, NICOLE (MD, PHD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LOWREY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 INSIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2146
Mailing Address - Country:US
Mailing Address - Phone:618-391-1660
Mailing Address - Fax:618-861-6003
Practice Address - Street 1:705 INSIGHT AVE
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2146
Practice Address - Country:US
Practice Address - Phone:618-391-1660
Practice Address - Fax:618-861-6003
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019018196207W00000X
IL036166546207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty