Provider Demographics
NPI:1558569319
Name:LAWTON, GARY ROBERT (RDO)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ROBERT
Last Name:LAWTON
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:1015 MAIN STREET
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520
Mailing Address - Country:US
Mailing Address - Phone:508-829-7333
Mailing Address - Fax:508-829-7285
Practice Address - Street 1:1015 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520
Practice Address - Country:US
Practice Address - Phone:508-829-7333
Practice Address - Fax:508-829-7285
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1441156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1529528Medicaid