MEDICARE: DR. LAWRENCE STAMER THAL O.D.

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	5955	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12451	OTHER	CA	MEDICAL EYE SERVICES

General Provider Information

NPI Number	:	1518909274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE STAMER THAL O.D.

Provider Business Mailing Address
First Line	:	291 ARLINGTON AVE
Second Line	:
City	:	KENSINGTON
State	:	CA
Zip	:	94707-1401
Country	:	US
Telephone Number	:	510-527-1714
Fax Number	:	510-527-1715

Provider Business Practice Location Address
First Line	:	291 ARLINGTON AVE
Second Line	:
City	:	KENSINGTON
State	:	CA
Zip	:	94707-1401
Country	:	US
Telephone Number	:	510-527-1714
Fax Number	:	510-527-1715

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	07/08/2007

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