Provider Demographics
NPI:1023129939
Name:YOO, LORI SHIM (OD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:SHIM
Last Name:YOO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:LEE
Other - Last Name:SHIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2831 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-2711
Mailing Address - Country:US
Mailing Address - Phone:714-931-3013
Mailing Address - Fax:
Practice Address - Street 1:2831 PARK AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-2711
Practice Address - Country:US
Practice Address - Phone:714-258-7525
Practice Address - Fax:714-258-8489
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12149T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U92383Medicare UPIN