Provider Demographics
NPI:1538242003
Name:ORTON, LARA (OD)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:
Last Name:ORTON
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 595
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-0595
Mailing Address - Country:US
Mailing Address - Phone:931-363-6147
Mailing Address - Fax:931-363-6155
Practice Address - Street 1:1000 EAST COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-0595
Practice Address - Country:US
Practice Address - Phone:931-363-6147
Practice Address - Fax:931-363-6155
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3943739Medicaid
TN410048312OtherMEDICARE RAILROAD
TNU82975Medicare UPIN
TN3943739Medicaid
TN3843739Medicare PIN