Healthcare Provider Details

I. General information

NPI: 1972555167
Provider Name (Legal Business Name): LAWRENCE WILLIAM ERNST O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 WEST VETERANS MEMORIAL PKWY
WARRENTON MO
63383-1211
US

IV. Provider business mailing address

277 WEST VETERANS MEMORIAL PKWY
WARRENTON MO
63383-1211
US

V. Phone/Fax

Practice location:
  • Phone: 636-456-2020
  • Fax:
Mailing address:
  • Phone: 636-456-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02923
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: