Provider Demographics
NPI:1033300629
Name:PALMER, LORI DANELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:DANELLE
Last Name:PALMER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:900 N AUSTIN AVE STE 605
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-4333
Mailing Address - Country:US
Mailing Address - Phone:512-869-6586
Mailing Address - Fax:512-859-6688
Practice Address - Street 1:900 N AUSTIN AVE STE 605
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-4333
Practice Address - Country:US
Practice Address - Phone:512-869-6586
Practice Address - Fax:512-859-6688
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7069TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist