Provider Demographics
NPI:1376593038
Name:FEEZOR-RIBBLE, LORI ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:FEEZOR-RIBBLE
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 1:1964 W MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-2621
Mailing Address - Country:US
Mailing Address - Phone:217-245-6070
Mailing Address - Fax:
Practice Address - Street 1:1964 W MORTON AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-2621
Practice Address - Country:US
Practice Address - Phone:217-245-6070
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU65193Medicare UPIN
IL590000Medicare ID - Type UnspecifiedPROVIDER NUMBER