Provider Demographics
NPI:1831216902
Name:LORENZO FAMILY OPTICAL, INC
Entity type:Organization
Organization Name:LORENZO FAMILY OPTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-837-8890
Mailing Address - Street 1:59 FRALEY ST
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-7915
Mailing Address - Country:US
Mailing Address - Phone:814-837-8890
Mailing Address - Fax:814-837-7410
Practice Address - Street 1:59 FRALEY ST
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-7915
Practice Address - Country:US
Practice Address - Phone:814-837-8890
Practice Address - Fax:814-837-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013197030002Medicaid
PA4717980001Medicare ID - Type Unspecified