MEDICARE: DELOR PARTNERSHIP, LLP

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	5256TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750619482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELOR PARTNERSHIP, LLP

Provider Business Mailing Address
First Line	:	3514 E BERRY ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-5305
Country	:	US
Telephone Number	:	817-534-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3514 E BERRY ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-5305
Country	:	US
Telephone Number	:	817-534-3200
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. GREGORY LORKOWSKI
Credential	:	O.D.
Telephone Number	:	817-534-3200

Provider Enumeration Date	:	11/18/2009
Last Update Date	:	04/01/2010

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