Provider Demographics
NPI:1275709909
Name:JOSEPH J. LAWLESS O.D.
Entity Type:Organization
Organization Name:JOSEPH J. LAWLESS O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LAWLESS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:586-725-7311
Mailing Address - Street 1:32901 23 MILE RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4063
Mailing Address - Country:US
Mailing Address - Phone:586-725-7311
Mailing Address - Fax:586-725-4166
Practice Address - Street 1:32901 23 MILE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4063
Practice Address - Country:US
Practice Address - Phone:586-725-7311
Practice Address - Fax:586-725-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2786332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM98940Medicare UPIN