Provider Demographics
NPI:1669525119
Name:OBENAUF DIGREGORY, LORI KAY
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:KAY
Last Name:OBENAUF DIGREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:K
Other - Last Name:DI GREGORY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:9760 LANTERN RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9612
Practice Address - Country:US
Practice Address - Phone:317-577-9200
Practice Address - Fax:317-570-4434
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002527A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU34055Medicare UPIN
IN317330BMedicare PIN