Provider Demographics
NPI:1265436083
Name:WEISS, LORI A (OD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:WEISS
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 1:110 MATHIS DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2000
Mailing Address - Country:US
Mailing Address - Phone:615-446-8089
Mailing Address - Fax:615-441-3135
Practice Address - Street 1:110 MATHIS DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2000
Practice Address - Country:US
Practice Address - Phone:615-446-8089
Practice Address - Fax:615-441-3135
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1063152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0393090004OtherDMERC
TNT61296Medicare UPIN
TN0393090004OtherDMERC