MEDICARE: DR. MICHAEL R LAUE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2004016783	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295707818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R LAUE OD

Provider Business Mailing Address
First Line	:	6100 RONALD REAGAN BLVD.
Second Line	:
City	:	LAKE ST. LOUIS
State	:	MO
Zip	:	63367
Country	:	US
Telephone Number	:	636-625-2143
Fax Number	:	636-625-2148

Provider Business Practice Location Address
First Line	:	6100 RONALD REAGAN BLVD.
Second Line	:
City	:	LAKE ST. LOUIS
State	:	MO
Zip	:	63367
Country	:	US
Telephone Number	:	636-625-2143
Fax Number	:	636-625-2148

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	12/11/2008

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Directions to “ DR. MICHAEL R LAUE OD” Practice Location

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