Healthcare Provider Details

I. General information

NPI: 1477585438
Provider Name (Legal Business Name): LAWRENCE B. KATZEN, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N CONGRESS AVE SUITE 104
BOYNTON BEACH FL
33426-3316
US

IV. Provider business mailing address

901 N CONGRESS AVE STE 104
BOYNTON BEACH FL
33426-3317
US

V. Phone/Fax

Practice location:
  • Phone: 561-732-8005
  • Fax: 561-732-0150
Mailing address:
  • Phone: 561-732-8005
  • Fax: 561-732-0150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE L NEAL
Title or Position: SECRETARY
Credential:
Phone: 469-214-0144