Healthcare Provider Details

I. General information

NPI: 1609874809
Provider Name (Legal Business Name): CHARLES A LAWRENCE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E OKLAHOMA AVE SUITE 101
ENID OK
73701-5951
US

IV. Provider business mailing address

615 E OKLAHOMA AVE SUITE 101
ENID OK
73701-5951
US

V. Phone/Fax

Practice location:
  • Phone: 580-233-4711
  • Fax: 580-234-6686
Mailing address:
  • Phone: 580-233-4711
  • Fax: 580-234-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number11287
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: