Provider Demographics
NPI:1376752444
Name:LOURDES LORINO, O.D.
Entity Type:Organization
Organization Name:LOURDES LORINO, O.D.
Other - Org Name:SPECIALTY EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:LORINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:219-662-0066
Mailing Address - Street 1:11420 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7106
Mailing Address - Country:US
Mailing Address - Phone:219-662-0066
Mailing Address - Fax:219-662-0055
Practice Address - Street 1:11420 BROADWAY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7106
Practice Address - Country:US
Practice Address - Phone:219-662-0066
Practice Address - Fax:219-662-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002818A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200245810BMedicaid
IN200245810BMedicaid
IN6187490001Medicare NSC
INU73108Medicare UPIN