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General NPI Number Information
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NPI Number | 1275681843
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Entity Type | Individual
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Provider Name | SEAN JOHN LAWLESS O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7153 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2103
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Country | US
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Telephone | 708-795-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 450 W MELROSE ST UNIT 236
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City | CHICAGO
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State | IL
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Zip | 60657-3837
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Country | US
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Telephone | 312-933-7613
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State | IL
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