Provider Demographics
NPI:1598720724
Name:RICHARD, LORI A (OD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:RICHARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:SARVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:937 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:IL
Mailing Address - Zip Code:61523-1823
Mailing Address - Country:US
Mailing Address - Phone:309-274-6404
Mailing Address - Fax:309-274-6404
Practice Address - Street 1:937 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:IL
Practice Address - Zip Code:61523-1823
Practice Address - Country:US
Practice Address - Phone:309-274-6404
Practice Address - Fax:309-274-6404
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008859152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0046008859Medicaid
410032012OtherRAILROAD MEDICARE
378280Medicare PIN
410032012OtherRAILROAD MEDICARE
IL0046008859Medicaid
IL1126580001Medicare NSC