MEDICARE: DR. LORI SHIM YOO OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	12149T	CA

General Provider Information

NPI Number	:	1023129939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI SHIM YOO OD

Provider Business Mailing Address
First Line	:	2831 PARK AVE
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-2711
Country	:	US
Telephone Number	:	714-931-3013
Fax Number	:

Provider Business Practice Location Address
First Line	:	2831 PARK AVE
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-2711
Country	:	US
Telephone Number	:	714-258-7525
Fax Number	:	714-258-8489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/10/2009

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