Healthcare Provider Details

I. General information

NPI: 1962507186
Provider Name (Legal Business Name): GARY M LAZARUS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 11/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5253 BUFFALO AVE
SHERMAN OAKS CA
91401-5930
US

IV. Provider business mailing address

5253 BUFFALO AVE
SHERMAN OAKS CA
91401-5930
US

V. Phone/Fax

Practice location:
  • Phone: 818-789-4697
  • Fax: 818-789-3618
Mailing address:
  • Phone: 818-789-4697
  • Fax: 818-789-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: