Healthcare Provider Details

I. General information

NPI: 1619082708
Provider Name (Legal Business Name): KENNETH WAYNE LAWSON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5632 26TH ST W
BRADENTON FL
34207
US

IV. Provider business mailing address

5632 26TH ST W
BRADENTON FL
34207-3515
US

V. Phone/Fax

Practice location:
  • Phone: 941-751-4668
  • Fax: 941-751-4809
Mailing address:
  • Phone: 941-751-4668
  • Fax: 941-751-4809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP2678
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: