Provider Demographics
NPI:1528119161
Name:LOW, EDWARD (OD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:LOW
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 1:783 CATTAIL CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-4641
Mailing Address - Country:US
Mailing Address - Phone:925-944-1429
Mailing Address - Fax:
Practice Address - Street 1:72840 HIGHWAY 111
Practice Address - Street 2:PALM DESERT TOWN CENTER #F201
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3324
Practice Address - Country:US
Practice Address - Phone:760-341-6324
Practice Address - Fax:760-341-3725
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5735T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10103Medicare UPIN
CASD0057351Medicare ID - Type Unspecified