Provider Demographics
NPI:1699873687
Name:KIRWAN, LORI SCHAFER (OD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:SCHAFER
Last Name:KIRWAN
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:PO BOX 1196
Mailing Address - Street 2:36 CENTER STREET #5
Mailing Address - City:WOLFEBORO FALLS
Mailing Address - State:NH
Mailing Address - Zip Code:03896-1196
Mailing Address - Country:US
Mailing Address - Phone:603-569-8500
Mailing Address - Fax:603-569-8905
Practice Address - Street 1:36 CENTER STREET
Practice Address - Street 2:#5
Practice Address - City:WOLFEBORO FALLS
Practice Address - State:NH
Practice Address - Zip Code:03896-1196
Practice Address - Country:US
Practice Address - Phone:603-569-8500
Practice Address - Fax:603-569-8905
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0685152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH09Y003748NH01OtherBC/BS
NH0685OtherSTATE LICENSE NUMBER
4993990001OtherDMERC REGION A
4993990001OtherDMERC REGION A
NHRE5534Medicare ID - Type Unspecified