Provider Demographics
NPI:1003877796
Name:LORINO, LOURDES (OD)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:LORINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11420 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7106
Mailing Address - Country:US
Mailing Address - Phone:219-662-0066
Mailing Address - Fax:219-662-0055
Practice Address - Street 1:528 INDIAN BOUNDARY RD
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-1515
Practice Address - Country:US
Practice Address - Phone:219-250-2470
Practice Address - Fax:219-728-1134
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002818A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200245810BMedicaid
IN251900Medicare PIN
INU73108Medicare UPIN
IN200245810BMedicaid