Healthcare Provider Details

I. General information

NPI: 1285553503
Provider Name (Legal Business Name): LORIANNA IRENE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4595 AVENUE E
WHITE CITY OR
97503-1400
US

IV. Provider business mailing address

PO BOX 314
EAGLE POINT OR
97524-0314
US

V. Phone/Fax

Practice location:
  • Phone: 541-951-8054
  • Fax:
Mailing address:
  • Phone: 541-951-8054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number260386
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: