Healthcare Provider Details

I. General information

NPI: 1033963798
Provider Name (Legal Business Name): LAWSEN PARKER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 TELEGRAPH RD
TAYLOR MI
48180-3330
US

IV. Provider business mailing address

1778 N VANTAGE POINT DR
WASHINGTON UT
84780-1360
US

V. Phone/Fax

Practice location:
  • Phone: 313-295-5000
  • Fax:
Mailing address:
  • Phone: 801-637-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number5151016634
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: