Provider Demographics
NPI:1508831439
Name:BERWALD, LORI D (OD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:D
Last Name:BERWALD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:D
Other - Last Name:MCQUIGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 219241
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9241
Mailing Address - Country:US
Mailing Address - Phone:913-829-5511
Mailing Address - Fax:913-829-5571
Practice Address - Street 1:21020 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7200
Practice Address - Country:US
Practice Address - Phone:913-829-5511
Practice Address - Fax:913-829-5571
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1576152W00000X
MO2000145672152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00167129OtherRAILROAD MEDICARE
U70943Medicare UPIN
KSK38A513Medicare PIN
KS6367830001Medicare NSC
MOQ95A513Medicare PIN