Provider Demographics
NPI:1477657815
Name:LAWRENCE, LINDA M
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 E IRON AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3285
Mailing Address - Country:US
Mailing Address - Phone:785-823-1600
Mailing Address - Fax:785-823-8953
Practice Address - Street 1:1410 E IRON AVE STE 6
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3285
Practice Address - Country:US
Practice Address - Phone:785-823-1600
Practice Address - Fax:785-823-8953
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2013-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421331207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100130950AMedicaid
KS051825Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
KS100130950AMedicaid