Healthcare Provider Details

I. General information

NPI: 1689656712
Provider Name (Legal Business Name): DAVID J LAX OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WHITEHORSE HAMILTON SQUARE RD
HAMILTON SQUARE NJ
08690-3536
US

IV. Provider business mailing address

1700 WHITEHORSE HAMILTON SQUARE RD
HAMILTON SQUARE NJ
08690-3536
US

V. Phone/Fax

Practice location:
  • Phone: 609-587-2020
  • Fax: 609-588-9545
Mailing address:
  • Phone: 609-587-2020
  • Fax: 609-588-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number270A00368900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number27T000071700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number27OA00368900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: