MEDICARE: MR. LAWRENCE HOWARD BAUER OPTICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1100X	Ophthalmic Technician/Technologist	659	VA

General Provider Information

NPI Number	:	1376551119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAWRENCE HOWARD BAUER OPTICIAN

Provider Business Mailing Address
First Line	:	4680 KING ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1215
Country	:	US
Telephone Number	:	703-671-1313
Fax Number	:

Provider Business Practice Location Address
First Line	:	4680 KING ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1215
Country	:	US
Telephone Number	:	703-671-1313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	02/05/2008

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