MEDICARE: JAMES X LAWRENCE OD

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	152W00000X	Optometrist	OPC001668	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2200636	OTHER	FL	AETNA
3	4317979	OTHER	FL	AETNA
4	9600540	OTHER	NY	GHI
5	19445A	OTHER	FL	BCBS FLORIDA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407849839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES X LAWRENCE OD

Provider Business Mailing Address
First Line	:	612 N TAMIAMI TRL
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-3769
Country	:	US
Telephone Number	:	813-645-3831
Fax Number	:	813-645-4402

Provider Business Practice Location Address
First Line	:	612 N TAMIAMI TRL
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-3769
Country	:	US
Telephone Number	:	813-645-3831
Fax Number	:	813-645-4402

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	05/18/2020

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