Basic Information
| Provider Information | |||||||||
| NPI: | 1215978465 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEALS | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | NICHOLS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NICHOLS | ||||||||
| OtherFirstName: | LORI | ||||||||
| OtherMiddleName: | DENISE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2118 ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432214314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144871022 | ||||||||
| FaxNumber: | 6144871030 | ||||||||
| Practice Location | |||||||||
| Address1: | 2118 ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432214314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144871022 | ||||||||
| FaxNumber: | 6144871030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4221 | OH | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.