Provider Demographics
NPI:1538475249
Name:LAWRENCE, NICHOLAS GEORGE (OD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:GEORGE
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 1:5890 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1547
Mailing Address - Country:US
Mailing Address - Phone:330-305-2200
Mailing Address - Fax:
Practice Address - Street 1:5890 MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1547
Practice Address - Country:US
Practice Address - Phone:330-305-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHT2873152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist