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General NPI Number Information
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NPI Number | 1982706636
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Entity Type | Individual
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Provider Name | LORI J. WASSMANN O.D. M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 1243 W BOUGHTON RD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1509
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Country | US
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Telephone | 630-679-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 1265 DANIEL CT
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City | SYCAMORE
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State | IL
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Zip | 60178-3207
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Country | US
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Telephone | 815-217-4246
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 046.007567
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License Number State | IL
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