Healthcare Provider Details

I. General information

NPI: 1194719757
Provider Name (Legal Business Name): LAWRENCE HASTINGS SCHOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 MICHIGAN RD SUITE 2
MADISON IN
47250-2491
US

IV. Provider business mailing address

122 ELMHURST LN
MADISON IN
47250-2912
US

V. Phone/Fax

Practice location:
  • Phone: 812-265-6222
  • Fax: 866-879-4830
Mailing address:
  • Phone: 812-273-2860
  • Fax: 866-879-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number01055597A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01055597A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: