Provider Demographics
NPI:1477641363
Name:FIORE, LOIS G (OD)
Entity type:Individual
Prefix:DR
First Name:LOIS
Middle Name:G
Last Name:FIORE
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 1:505 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033
Mailing Address - Country:US
Mailing Address - Phone:908-272-3293
Mailing Address - Fax:908-276-5227
Practice Address - Street 1:505 BOULEVARD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033
Practice Address - Country:US
Practice Address - Phone:908-272-3293
Practice Address - Fax:908-276-5227
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ3967152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU05629Medicare UPIN
NJ631826Medicare ID - Type Unspecified