Provider Demographics
NPI:1275681843
Name:LAWLESS, SEAN JOHN (OD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:JOHN
Last Name:LAWLESS
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 1:450 W MELROSE ST
Mailing Address - Street 2:UNIT 236
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3837
Mailing Address - Country:US
Mailing Address - Phone:312-933-7613
Mailing Address - Fax:
Practice Address - Street 1:7153 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2103
Practice Address - Country:US
Practice Address - Phone:708-795-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU97408Medicare UPIN
ILK01846Medicare ID - Type Unspecified