MEDICARE: DR. LAWRENCE R STERN 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	A805	AZ
2	152W00000X	Optometrist	FLA2564	FL

General Provider Information

NPI Number	:	1326045618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE R STERN OD

Provider Business Mailing Address
First Line	:	3655 W ANTHEM WAY
Second Line	:	STE B149
City	:	ANTHEM
State	:	AZ
Zip	:	85086-0435
Country	:	US
Telephone Number	:	623-879-3937
Fax Number	:	623-551-1700

Provider Business Practice Location Address
First Line	:	3655 W ANTHEM WAY
Second Line	:	STE B149
City	:	ANTHEM
State	:	AZ
Zip	:	85086-0430
Country	:	US
Telephone Number	:	623-879-3937
Fax Number	:	623-551-1700

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	02/03/2009

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