Provider Demographics
NPI:1780649566
Name:HOOLEY, LORI K (OD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:K
Last Name:HOOLEY
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 1:60 S 200 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2412
Mailing Address - Country:US
Mailing Address - Phone:801-756-4731
Mailing Address - Fax:801-756-5865
Practice Address - Street 1:60 S 200 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2412
Practice Address - Country:US
Practice Address - Phone:801-756-4731
Practice Address - Fax:801-756-5865
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56762279934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTV00279Medicare UPIN
005770702Medicare ID - Type Unspecified