Provider Demographics
NPI:1376551119
Name:BAUER, LAWRENCE HOWARD (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:HOWARD
Last Name:BAUER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4680 KING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1215
Mailing Address - Country:US
Mailing Address - Phone:703-671-1313
Mailing Address - Fax:
Practice Address - Street 1:4680 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1215
Practice Address - Country:US
Practice Address - Phone:703-671-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA659156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic