Healthcare Provider Details

I. General information

NPI: 1114107802
Provider Name (Legal Business Name): LAWRENCE G MOCK, O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 N BROADWAY
WALNUT CREEK CA
94596-4636
US

IV. Provider business mailing address

1389 N BROADWAY
WALNUT CREEK CA
94596-4636
US

V. Phone/Fax

Practice location:
  • Phone: 925-930-7484
  • Fax: 925-930-7469
Mailing address:
  • Phone: 925-930-7484
  • Fax: 925-930-7469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LAWRANCE G MOCK
Title or Position: OWNER
Credential: OD
Phone: 925-930-7484