Healthcare Provider Details

I. General information

NPI: 1962568311
Provider Name (Legal Business Name): LAWRENCE PAUL FRANKEL OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1092 RT 112
PORT JEFFERSON STA NY
11776
US

IV. Provider business mailing address

1092 RT 112
PORT JEFFERSON STA NY
11776
US

V. Phone/Fax

Practice location:
  • Phone: 631-474-3937
  • Fax: 631-474-3966
Mailing address:
  • Phone: 631-474-3937
  • Fax: 631-474-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number8108-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: