Basic Information
| Provider Information | |||||||||
| NPI: | 1902182272 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LORI RAYNOR O.D., PA. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LORI RAYNOR, O.D. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5911 NW 60TH AVE | ||||||||
| Address2: | |||||||||
| City: | PARKLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330674407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543454123 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6618 W ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334461616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614985007 | ||||||||
| FaxNumber: | 5614963088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2011 | ||||||||
| LastUpdateDate: | 10/31/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RAYNOR | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9543454123 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.