Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 10551 | CA |
NPI | 1013427962 |
---|---|
Provider Name | Lori Schafer |
First Address | Ukiah, CA 95482-4555 |
Second Address | Ukiah, CA 95482-4555 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2017 |
Last Update Date | 05/10/2017 |