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General NPI Number Information
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NPI Number | 1154591097
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Entity Type | Organization
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Legal Business Name | LAWRENCE A. STRANCH
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 522 OHIO AVE S
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City | LIVE OAK
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State | FL
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Zip | 32064-3219
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Country | US
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Telephone | 386-364-7793
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX F
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City | LIVE OAK
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State | FL
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Zip | 32064-0300
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Country | US
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Telephone | 386-364-7793
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAWRENCE A. STRANCH
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Credential | O.D.
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Telephone | 386-364-7793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OPC 000767
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License Number State | FL
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