Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 18002818A | IN |
NPI | 1003877796 |
---|---|
Provider Name | Lourdes Lorino |
First Address | Crown Point, IN 46307-7106 |
Second Address | Chesterton, IN 46304-1515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 04/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200245810B | (05) | IN |
U73108 | (02) | IN |