=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205978848
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAWRENCE MORRIS O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11640 CENTRAL AVE
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-627-7363
-----------------------------------------------------
Fax | 909-627-9854
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11640 CENTRAL AVE
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-627-7363
-----------------------------------------------------
Fax | 909-627-9854
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT7531TPA
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------