Provider Demographics
NPI:1457427015
Name:DR LORI F MERRITT
Entity type:Organization
Organization Name:DR LORI F MERRITT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:FERTIG
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-763-5220
Mailing Address - Street 1:19219 STATE HIGHWAY 198
Mailing Address - Street 2:
Mailing Address - City:SAEGERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:16433-4529
Mailing Address - Country:US
Mailing Address - Phone:814-763-5220
Mailing Address - Fax:814-763-4425
Practice Address - Street 1:19219 STATE HIGHWAY 198
Practice Address - Street 2:
Practice Address - City:SAEGERTOWN
Practice Address - State:PA
Practice Address - Zip Code:16433-4529
Practice Address - Country:US
Practice Address - Phone:814-763-5220
Practice Address - Fax:814-763-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U33160Medicare UPIN
PAME735137Medicare ID - Type Unspecified