Provider Demographics
NPI:1407801756
Name:EDMUNDS, LORNA ELIZABETH (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:LORNA
Middle Name:ELIZABETH
Last Name:EDMUNDS
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 SW BOND AVE
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-494-3000
Mailing Address - Fax:503-418-0834
Practice Address - Street 1:3303 SW BOND AVE
Practice Address - Street 2:11TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-418-2266
Practice Address - Fax:503-418-9375
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL14890207W00000X
ORMD126332207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR270058Medicaid
I46120Medicare UPIN
OR133292Medicare ID - Type Unspecified