Provider Demographics
NPI:1417922881
Name:LAVIN, PAUL JAIMEY (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JAIMEY
Last Name:LAVIN
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 1:655 SATURN BLVD
Mailing Address - Street 2:STE. H
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-4734
Mailing Address - Country:US
Mailing Address - Phone:619-425-9001
Mailing Address - Fax:619-423-3807
Practice Address - Street 1:655 SATURN BLVD
Practice Address - Street 2:STE. H
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-4734
Practice Address - Country:US
Practice Address - Phone:619-425-9001
Practice Address - Fax:619-423-3807
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP6591T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP6591Medicare PIN
CAT70122Medicare UPIN
CA0228050001Medicare NSC