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General NPI Number Information
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NPI Number | 1376752444
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Entity Type | Organization
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Legal Business Name | LOURDES LORINO, O.D.
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 12/06/2013
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Provider Practice Location Address
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Address Line | 11420 BROADWAY
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City | CROWN POINT
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State | IN
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Zip | 46307-7106
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Country | US
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Telephone | 219-662-0066
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Fax | 219-662-0055
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Provider Business Mailing Address
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Address Line | 11420 BROADWAY
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City | CROWN POINT
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State | IN
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Zip | 46307-7106
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Country | US
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Telephone | 219-662-0066
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Fax | 219-662-0055
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOURDES LORINO
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Credential | O.D.
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Telephone | 219-662-0066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18002818A
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License Number State | IN
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