Provider Demographics
NPI:1275623373
Name:LONN, LAWRENCE I (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:I
Last Name:LONN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 W SHORE RD
Mailing Address - Street 2:
Mailing Address - City:BELVEDERE
Mailing Address - State:CA
Mailing Address - Zip Code:94920-2461
Mailing Address - Country:US
Mailing Address - Phone:415-435-4443
Mailing Address - Fax:
Practice Address - Street 1:75 W SHORE RD
Practice Address - Street 2:
Practice Address - City:BELVEDERE
Practice Address - State:CA
Practice Address - Zip Code:94920-2461
Practice Address - Country:US
Practice Address - Phone:415-435-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG7771207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G77710Medicaid
CA000G77710Medicaid
CAA58006Medicare UPIN