Provider Demographics
NPI:1306993613
Name:FLOYD, LORI LEIGH (OD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:LEIGH
Last Name:FLOYD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24000 ALICIA PKWY
Mailing Address - Street 2:SUITE # 11
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3929
Mailing Address - Country:US
Mailing Address - Phone:949-768-0331
Mailing Address - Fax:
Practice Address - Street 1:24000 ALICIA PKWY
Practice Address - Street 2:SUITE # 11
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-3929
Practice Address - Country:US
Practice Address - Phone:949-768-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9748T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP9748Medicare ID - Type Unspecified
CAU37349Medicare UPIN