Provider Demographics
NPI:1538185145
Name:KENDRICK, LORI ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:ELIZABETH
Last Name:KENDRICK
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 1:2817 BARTLETT BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-4529
Mailing Address - Country:US
Mailing Address - Phone:901-371-0770
Mailing Address - Fax:901-371-0770
Practice Address - Street 1:2817 BARTLETT BLVD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4529
Practice Address - Country:US
Practice Address - Phone:901-371-0770
Practice Address - Fax:901-371-0770
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNOD1637152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U59262Medicare UPIN