Provider Demographics
NPI:1215978465
Name:BEALS, LORI NICHOLS (OD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:NICHOLS
Last Name:BEALS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:DENISE
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2118 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-4314
Mailing Address - Country:US
Mailing Address - Phone:614-487-1022
Mailing Address - Fax:614-487-1030
Practice Address - Street 1:2118 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-4314
Practice Address - Country:US
Practice Address - Phone:614-487-1022
Practice Address - Fax:614-487-1030
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU10167Medicare UPIN
OHNI0685155Medicare ID - Type Unspecified