Healthcare Provider Details

I. General information

NPI: 1164551651
Provider Name (Legal Business Name): JOHN EDWARD LAMOTHE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 RHODE ISLAND AVE NW SUITE 210
WASHINGTON DC
20036
US

IV. Provider business mailing address

3303 WATER ST NW UNIT 4L
WASHINGTON DC
20007-3576
US

V. Phone/Fax

Practice location:
  • Phone: 202-558-3824
  • Fax:
Mailing address:
  • Phone: 202-986-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1000037
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: