Healthcare Provider Details

I. General information

NPI: 1649775214
Provider Name (Legal Business Name): BRENDAN MCKAY LAWSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CHERRY ST
MILFORD CT
06460-3538
US

IV. Provider business mailing address

202 CHERRY ST
MILFORD CT
06460-3538
US

V. Phone/Fax

Practice location:
  • Phone: 203-878-1236
  • Fax: 203-874-8838
Mailing address:
  • Phone: 203-878-1236
  • Fax: 203-874-8838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number291595
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number73437
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: