Provider Demographics
NPI:1790571644
Name:STRAIN, LORI (CCSH)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:STRAIN
Suffix:
Gender:
Credentials:CCSH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 E WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2819
Mailing Address - Country:US
Mailing Address - Phone:801-213-2724
Mailing Address - Fax:801-587-3349
Practice Address - Street 1:1138 E WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2819
Practice Address - Country:US
Practice Address - Phone:801-213-2724
Practice Address - Fax:801-587-3349
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
806156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist