Healthcare Provider Details

I. General information

NPI: 1346168440
Provider Name (Legal Business Name): LAWRENCE SUNGA YABUT OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 GRANT AVE
DUMONT NJ
07628-1651
US

IV. Provider business mailing address

52 GRANT AVE
DUMONT NJ
07628-1651
US

V. Phone/Fax

Practice location:
  • Phone: 201-385-3055
  • Fax: 201-385-3011
Mailing address:
  • Phone: 201-385-3055
  • Fax: 201-385-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OM00212500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00744200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: