Individual
ELISE AUBREY LORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D
Contact information
Practice address
744 E 3RD ST, BLOOMINGTON, IN 47405-3603
(812) 855-8436
(812) 855-1683
Mailing address
800 E ATWATER AVE, RM 264, BLOOMINGTON, IN 47405-3635
(812) 855-3670
(812) 855-6116
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003905A
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201298910
—
IN
Enumeration date
06/24/2015
Last updated
10/21/2015
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