Provider Demographics
NPI:1356490130
Name:MACFARLANE, LORI ANDRA (OD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANDRA
Last Name:MACFARLANE
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 1:1933 CENTRAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3668
Mailing Address - Country:US
Mailing Address - Phone:707-839-2828
Mailing Address - Fax:707-839-3715
Practice Address - Street 1:1933 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3668
Practice Address - Country:US
Practice Address - Phone:707-839-2828
Practice Address - Fax:707-839-3715
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9439T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0094390Medicaid
CAU18583Medicare UPIN
CASD0094390Medicare ID - Type Unspecified