Provider Demographics
NPI:1962608851
Name:LORI H BALMER ODPC
Entity type:Organization
Organization Name:LORI H BALMER ODPC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:H
Authorized Official - Last Name:BALMER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-479-4174
Mailing Address - Street 1:3103 OCOEE ST N
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-5381
Mailing Address - Country:US
Mailing Address - Phone:423-479-4174
Mailing Address - Fax:423-479-4346
Practice Address - Street 1:3103 OCOEE ST N
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5381
Practice Address - Country:US
Practice Address - Phone:423-479-4174
Practice Address - Fax:423-479-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1119050001Medicare NSC