Provider Demographics
NPI:1487279618
Name:DYKES, LORI (LDO CLDO)
Entity type:Individual
Prefix:MISS
First Name:LORI
Middle Name:
Last Name:DYKES
Suffix:
Gender:F
Credentials:LDO CLDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 HIGHWAY 378 STE A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-8379
Mailing Address - Country:US
Mailing Address - Phone:803-756-3460
Mailing Address - Fax:803-756-3462
Practice Address - Street 1:808 HIGHWAY 378 STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-8379
Practice Address - Country:US
Practice Address - Phone:803-756-3460
Practice Address - Fax:803-756-3462
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1026156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician