Provider Demographics
NPI:1467459024
Name:LAWSON, MICHAEL EUGENE (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EUGENE
Last Name:LAWSON
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 1:5431 EVERHART RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4805
Mailing Address - Country:US
Mailing Address - Phone:361-851-2020
Mailing Address - Fax:361-852-1210
Practice Address - Street 1:5431 EVERHART RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4805
Practice Address - Country:US
Practice Address - Phone:361-851-2020
Practice Address - Fax:361-852-1210
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2616TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80314EOtherBLUE CROSS BLUE SHIELD
TX83007EOtherBCBS SINTON
TX019384901Medicaid
TX80314EMedicare ID - Type Unspecified
TX00E50WMedicare ID - Type UnspecifiedSINTON MEDICARE
TX83007EOtherBCBS SINTON