Healthcare Provider Details

I. General information

NPI: 1114110467
Provider Name (Legal Business Name): ANUPAM LAUL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 42ND ST UNIVERSITY EYE CENTER - SUNY OPTOMETRY
NEW YORK NY
10036-8005
US

IV. Provider business mailing address

33 W 42ND ST UNIVERSITY EYE CENTER - SUNY OPTOMETRY
NEW YORK NY
10036-8005
US

V. Phone/Fax

Practice location:
  • Phone: 212-938-4001
  • Fax:
Mailing address:
  • Phone: 212-938-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2333
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number008535
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: