Provider Demographics
NPI:1154498210
Name:MAY, LARA E (OD)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:E
Last Name:MAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503
Mailing Address - Country:US
Mailing Address - Phone:903-831-5706
Mailing Address - Fax:903-865-5420
Practice Address - Street 1:2901 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503
Practice Address - Country:US
Practice Address - Phone:903-831-5706
Practice Address - Fax:903-865-5420
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOP0000002198152W00000X
TX5873T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518733Medicaid
TN1518733Medicaid
TN3945562Medicaid