Provider Demographics
NPI:1720215361
Name:LOWDERMILK, STACY L (OD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:L
Last Name:LOWDERMILK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:STIEGELBAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1055 S HUNT ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-9702
Mailing Address - Country:US
Mailing Address - Phone:812-249-2068
Mailing Address - Fax:812-665-0083
Practice Address - Street 1:1055 S HUNT ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-9702
Practice Address - Country:US
Practice Address - Phone:812-244-1481
Practice Address - Fax:126-650-0838
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003587A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN859940002Medicare PIN
IN265130009Medicare PIN