Healthcare Provider Details

I. General information

NPI: 1609872738
Provider Name (Legal Business Name): ZOE K. LAZAROU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 LORD BALTIMORE DR. STE 300
BALTIMORE MD
21244-2568
US

IV. Provider business mailing address

2925 LORD BALTIMORE DR. STE 300
BALTIMORE MD
21244-2568
US

V. Phone/Fax

Practice location:
  • Phone: 410-277-3937
  • Fax: 410-281-9388
Mailing address:
  • Phone: 410-277-3937
  • Fax: 410-281-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1633
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: