Provider Demographics
NPI:1326662834
Name:CRETELLA, LORA
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:CRETELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-4117
Mailing Address - Country:US
Mailing Address - Phone:828-456-8361
Mailing Address - Fax:828-452-4527
Practice Address - Street 1:1604 SULPHUR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-4117
Practice Address - Country:US
Practice Address - Phone:828-456-8361
Practice Address - Fax:828-452-4527
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60967166152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist