Provider Demographics
NPI:1902182272
Name:LORI RAYNOR O.D., PA.
Entity Type:Organization
Organization Name:LORI RAYNOR O.D., PA.
Other - Org Name:LORI RAYNOR, O.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-345-4123
Mailing Address - Street 1:5911 NW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4407
Mailing Address - Country:US
Mailing Address - Phone:954-345-4123
Mailing Address - Fax:
Practice Address - Street 1:6618 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1616
Practice Address - Country:US
Practice Address - Phone:561-498-5007
Practice Address - Fax:561-496-3088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty