Provider Demographics
NPI:1255498838
Name:LAX, ALAN (OD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:LAX
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 CENTRAL PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1133
Mailing Address - Country:US
Mailing Address - Phone:914-337-2100
Mailing Address - Fax:914-337-2106
Practice Address - Street 1:2500 CENTRAL PARK AVENUE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1133
Practice Address - Country:US
Practice Address - Phone:914-337-2100
Practice Address - Fax:914-337-2106
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT0033731152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00511037Medicaid
NYC25821Medicare PIN
NY00511037Medicaid