Provider Demographics
NPI:1831113430
Name:SCHELM, LORI L (OD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:SCHELM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CARONDELET DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4802
Mailing Address - Country:US
Mailing Address - Phone:816-942-8333
Mailing Address - Fax:816-942-6663
Practice Address - Street 1:1004 CARONDELET DR
Practice Address - Street 2:SUITE 400
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4802
Practice Address - Country:US
Practice Address - Phone:816-942-8333
Practice Address - Fax:816-942-6663
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
180028565OtherRAILROAD MEDICARE NUMBER
0855287OtherAETNA HMO PROVIDER NUMBER
23215047OtherBC/BS PROVIDER NUMBER
5579595OtherAETNA PPO PROVIDER NUMBER
23215047OtherBC/BS PROVIDER NUMBER
180028565OtherRAILROAD MEDICARE NUMBER
23215047OtherBC/BS PROVIDER NUMBER