Provider Demographics
NPI:1134258429
Name:EPSTEIN, LORI ELLEN (OPTICIAN)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ELLEN
Last Name:EPSTEIN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-2908
Mailing Address - Country:US
Mailing Address - Phone:617-742-3937
Mailing Address - Fax:617-577-9978
Practice Address - Street 1:101 STATE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-2908
Practice Address - Country:US
Practice Address - Phone:617-742-3937
Practice Address - Fax:617-577-9978
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1889156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA1889OtherEYEMED