Provider Demographics
NPI:1891073839
Name:RIGGERS-LASSMAN, LORRAINE DOLORES (OD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:DOLORES
Last Name:RIGGERS-LASSMAN
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 1:10158 MAXINE ST
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6317
Mailing Address - Country:US
Mailing Address - Phone:410-480-9285
Mailing Address - Fax:
Practice Address - Street 1:2700 POTOMAC MILLS CIR
Practice Address - Street 2:SUITE 208B
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4625
Practice Address - Country:US
Practice Address - Phone:703-490-5275
Practice Address - Fax:703-490-1196
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000481152W00000X
MDDA 2260152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU62882Medicare UPIN