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NPI Code Detail

MEDICARE: DR. LAWRENCE MATTHEW DAWSON JR. O.D.

MEDICARE: DR. LAWRENCE MATTHEW DAWSON JR. O.D.
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
1152W00000XOptometrist721LA

General Provider Information

NPI Number : 1609974930
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAWRENCE MATTHEW DAWSON JR. O.D.
Provider Business Mailing Address
First Line : 13634 RIDGEVIEW DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70817-3435
Country : US
Telephone Number : 225-753-7521
Fax Number :
Provider Business Practice Location Address
First Line : 28270 WALKER RD S
Second Line :
City : WALKER
State : LA
Zip : 70785-6028
Country : US
Telephone Number : 225-667-0214
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/08/2007

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