Provider Demographics
NPI:1538173133
Name:MCSTOOTS, LORI AKRIDGE (OD)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:AKRIDGE
Last Name:MCSTOOTS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:CALDWELL
Other - Last Name:AKRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:10232 WESTPORT RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2148
Mailing Address - Country:US
Mailing Address - Phone:205-807-7216
Mailing Address - Fax:
Practice Address - Street 1:10232 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241
Practice Address - Country:US
Practice Address - Phone:205-807-7216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2102DT152W00000X
ALS-BO4-TA-712152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist