Provider Demographics
NPI:1427035930
Name:LAWRENCE, AARON BRETT (OD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:BRETT
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 1:33 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CONCORD
Mailing Address - State:OH
Mailing Address - Zip Code:43762-1214
Mailing Address - Country:US
Mailing Address - Phone:740-826-1111
Mailing Address - Fax:740-825-2222
Practice Address - Street 1:33 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CONCORD
Practice Address - State:OH
Practice Address - Zip Code:43762-1214
Practice Address - Country:US
Practice Address - Phone:740-826-1111
Practice Address - Fax:740-826-2222
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4948152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2091632Medicaid
OHU72578Medicare UPIN
OHH226800Medicare PIN
OH1326530001Medicare NSC