Provider Demographics
NPI:1407849839
Name:LAWRENCE, JAMES X (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:X
Last Name:LAWRENCE
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 1:612 N TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-3769
Mailing Address - Country:US
Mailing Address - Phone:813-645-3831
Mailing Address - Fax:813-645-4402
Practice Address - Street 1:612 N TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-3769
Practice Address - Country:US
Practice Address - Phone:813-645-3831
Practice Address - Fax:813-645-4402
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001668152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078359500Medicaid
FL2200636OtherAETNA
FL4317979OtherAETNA
NY9600540OtherGHI
FL19445AOtherBCBS FLORIDA
NY9600540OtherGHI
FL19445XMedicare PIN
FL078359500Medicaid
GA410038872Medicare PIN
FLT85240Medicare UPIN