Provider Demographics
NPI:1346358025
Name:RAYNOR, LORI R (OD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:R
Last Name:RAYNOR
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 1:5911 NW 60 AVENUE
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067
Mailing Address - Country:US
Mailing Address - Phone:954-345-4123
Mailing Address - Fax:
Practice Address - Street 1:6618 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1616
Practice Address - Country:US
Practice Address - Phone:561-498-5007
Practice Address - Fax:561-496-3088
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621096100Medicaid
FLU71116Medicare UPIN
FL19561AMedicare ID - Type Unspecified