Provider Demographics
NPI:1144295502
Name:SHULMAN, LORI ZLATKIS (OD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:ZLATKIS
Last Name:SHULMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:4011 FM 1463 RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5400
Practice Address - Country:US
Practice Address - Phone:281-644-2020
Practice Address - Fax:281-574-8307
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03110TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208639901Medicaid
TX11616009OtherCAQH
TX11616009OtherCAQH