Provider Demographics
NPI:1083794101
Name:CICCHINI, LORI (OD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:CICCHINI
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 1:527 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-1426
Mailing Address - Country:US
Mailing Address - Phone:724-929-7737
Mailing Address - Fax:
Practice Address - Street 1:527 BROAD AVE
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-1426
Practice Address - Country:US
Practice Address - Phone:724-929-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000790152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG000790OtherSTATE LISCENE #
PAMC0573205OtherDEA #
PAOEG000790OtherSTATE LISCENE #