Individual
DR. LORI L DEWALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
980 W SOUTH ST, FREEPORT, IL 61032-6777
(815) 235-3466
(815) 235-1712
Mailing address
980 W SOUTH ST, FREEPORT, IL 61032-6777
(815) 235-3466
(815) 235-1712
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
46-8516
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46-8516
—
IL
Enumeration date
08/19/2006
Last updated
02/17/2023
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