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General NPI Number Information
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NPI Number | 1073709283
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Entity Type | Organization
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Legal Business Name | CONNIE LAWRENCE-WILLIS OD PA
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 2001 US HIGHWAY 1
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City | SEBASTIAN
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State | FL
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Zip | 32958-1615
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Country | US
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Telephone | 772-589-7337
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Fax | 772-589-9238
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Provider Business Mailing Address
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Address Line | 13 SUNSET DR
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City | SEBASTIAN
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State | FL
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Zip | 32958-3508
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Country | US
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Telephone | 772-589-7337
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Fax | 772-589-9238
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. CONNIE LAWRENCE-WILLIS
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Credential | O.D.
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Telephone | 772-589-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC3016
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License Number State | FL
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