Provider Demographics
NPI:1124122775
Name:LOGAN, LORIE ANNE (OD)
Entity type:Individual
Prefix:DR
First Name:LORIE
Middle Name:ANNE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8180 GREENSBORO DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3888
Mailing Address - Country:US
Mailing Address - Phone:703-827-5454
Mailing Address - Fax:703-827-5539
Practice Address - Street 1:8180 GREENSBORO DR
Practice Address - Street 2:SUITE 140
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3888
Practice Address - Country:US
Practice Address - Phone:703-827-5454
Practice Address - Fax:703-827-5539
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005681C41Medicare ID - Type Unspecified
VAU81452Medicare UPIN