Provider Demographics
NPI:1285497263
Name:DOZMATI, LORNA
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:
Last Name:DOZMATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 PROGRESS WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-7710
Mailing Address - Country:US
Mailing Address - Phone:937-655-8137
Mailing Address - Fax:937-655-8188
Practice Address - Street 1:2825 PROGRESS WAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-7710
Practice Address - Country:US
Practice Address - Phone:937-655-8137
Practice Address - Fax:937-655-8188
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.017686-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician