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General NPI Number Information
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NPI Number | 1932395167
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Entity Type | Organization
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Legal Business Name | DR. LAWRENCE HADDAD & ASSOC.
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 16771 TORRENCE AVE
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City | LANSING
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State | IL
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Zip | 60438-6018
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Country | US
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Telephone | 708-474-9369
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Fax |
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Provider Business Mailing Address
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Address Line | 16771 TORRENCE AVE
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City | LANSING
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State | IL
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Zip | 60438-6018
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. LAWRENCE HADDAD
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Credential | O.D.
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Telephone | 773-771-4549
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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 | 046009114
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License Number State | IL
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