Provider Demographics
NPI:1871550046
Name:CAMP, LORI (OD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:CAMP
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 1:9122 58TH DR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-9187
Mailing Address - Country:US
Mailing Address - Phone:941-752-2020
Mailing Address - Fax:
Practice Address - Street 1:9122 58TH DR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-9187
Practice Address - Country:US
Practice Address - Phone:941-752-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-29
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP02495152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078884800Medicaid
FL410047284Medicare PIN
FL20367ZMedicare PIN
FLU13453Medicare UPIN
FL20367YMedicare PIN