Provider Demographics
NPI:1275691875
Name:LAURO, PATRICK (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:LAURO
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 1:3530 ATLANTIC AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4569
Mailing Address - Country:US
Mailing Address - Phone:562-424-6938
Mailing Address - Fax:562-595-7152
Practice Address - Street 1:3530 ATLANTIC AVE
Practice Address - Street 2:STE 106
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4569
Practice Address - Country:US
Practice Address - Phone:562-424-6938
Practice Address - Fax:562-595-7152
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8772T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0087720Medicaid
CAT70285Medicare UPIN
CASD0087720Medicaid
CAOP8772Medicare PIN