=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770770745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. LAURA FIORENZA, O.D. LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2007
-----------------------------------------------------
Last Update Date | 06/25/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11304 MONTGOMERY RD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45249-2313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-489-3937
-----------------------------------------------------
Fax | 513-489-3936
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11304 MONTGOMERY RD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45249-2313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-489-3937
-----------------------------------------------------
Fax | 513-489-3936
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. LAURA LEE FIORENZA
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 513-489-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4740
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------