Provider Demographics
NPI:1376549535
Name:SMITH, LORA JANE (OD)
Entity Type:Individual
Prefix:DR
First Name:LORA
Middle Name:JANE
Last Name:SMITH
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 1:4854 LONDONDERRY RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5207
Mailing Address - Country:US
Mailing Address - Phone:717-657-3682
Mailing Address - Fax:717-909-9162
Practice Address - Street 1:4854 LONDONDERRY RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5207
Practice Address - Country:US
Practice Address - Phone:717-657-3682
Practice Address - Fax:717-909-9162
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-08-29
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
PAOEG 000015152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA992170OtherKEYSTONE HEALTH SERVICES
PA50001250OtherCAPTIAL BLUE CROS
PA798437-004OtherCIGNA HEALTH CARE
PASM196369OtherHIGHMARK BLUE SHIELD
PA151427OtherHEALTH AMERICA/ASSURANCE
PAU62976Medicare UPIN