Provider Demographics
NPI:1144355975
Name:LOWE, SHELLY HOLCOMB (OD)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:HOLCOMB
Last Name:LOWE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:729 MISSION ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3072
Mailing Address - Country:US
Mailing Address - Phone:626-441-5300
Mailing Address - Fax:626-441-2880
Practice Address - Street 1:729 MISSION ST STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3072
Practice Address - Country:US
Practice Address - Phone:626-441-5300
Practice Address - Fax:626-441-2880
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8251T152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA03073OtherMEDICAL EYE SERVICES
CA03073OtherMEDICAL EYE SERVICES
U23565Medicare UPIN
CA03073OtherMEDICAL EYE SERVICES