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NPI Code Detail

MEDICARE: MR. GARY M LAZARUS O.D.

MEDICARE: MR. GARY M LAZARUS 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
1152W00000XOptometrist5171CA

General Provider Information

NPI Number : 1962507186
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GARY M LAZARUS O.D.
Provider Business Mailing Address
First Line : 5253 BUFFALO AVE
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91401-5930
Country : US
Telephone Number : 818-789-4697
Fax Number : 818-789-3618
Provider Business Practice Location Address
First Line : 5253 BUFFALO AVE
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91401-5930
Country : US
Telephone Number : 818-789-4697
Fax Number : 818-789-3618
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 11/30/2025

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