Healthcare Provider Details

I. General information

NPI: 1346358025
Provider Name (Legal Business Name): LORI R RAYNOR O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6618 W ATLANTIC AVE
DELRAY BEACH FL
33446-1616
US

IV. Provider business mailing address

5911 NW 60 AVENUE
PARKLAND FL
33067
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-5007
  • Fax: 561-496-3088
Mailing address:
  • Phone: 954-345-4123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC2253
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: