Provider Demographics
NPI:1679313191
Name:LOWERY, JONATHAN THOMAS (OD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:THOMAS
Last Name:LOWERY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 SPRING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-7020
Mailing Address - Country:US
Mailing Address - Phone:936-652-3341
Mailing Address - Fax:
Practice Address - Street 1:3208 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2633
Practice Address - Country:US
Practice Address - Phone:936-564-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11126152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist