Provider Demographics
NPI:1164855029
Name:LAWING, PEI-WEN (OD)
Entity Type:Individual
Prefix:DR
First Name:PEI-WEN
Middle Name:
Last Name:LAWING
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 1:14359 CHERRY LAKE DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5185
Mailing Address - Country:US
Mailing Address - Phone:904-309-4833
Mailing Address - Fax:
Practice Address - Street 1:4668 TOWN CROSSING DR
Practice Address - Street 2:#143
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7421
Practice Address - Country:US
Practice Address - Phone:904-641-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002622152W00000X
FLOPC4801152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist