Provider Demographics
NPI:1083752570
Name:CANFIELD, LORI J (OD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:J
Last Name:CANFIELD
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 1:317 EAST PARKWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3915
Mailing Address - Country:US
Mailing Address - Phone:479-967-6113
Mailing Address - Fax:479-968-6932
Practice Address - Street 1:317 EAST PARKWAY DRIVE
Practice Address - Street 2:DAIBER VISION CARE
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3915
Practice Address - Country:US
Practice Address - Phone:479-967-6113
Practice Address - Fax:479-968-6932
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2522152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7069287OtherAETNA
AR49790OtherARKANSAS BCBS
AR145334722Medicaid
AR06020018300OtherQUALCHOICE
ARAR2522OtherEYEMED
ARA003OtherTRICARE
ARAR0033029OtherHUMANA
ARA003OtherTRICARE
U89535Medicare UPIN