Provider Demographics
NPI:1821001389
Name:SMOLINSKI, LORI ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:SMOLINSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:MASTALANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:42 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-6605
Mailing Address - Country:US
Mailing Address - Phone:616-403-2990
Mailing Address - Fax:616-458-7113
Practice Address - Street 1:456 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4626
Practice Address - Country:US
Practice Address - Phone:616-458-1187
Practice Address - Fax:616-458-7113
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004066152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU83108Medicare UPIN