Provider Demographics
NPI:1588619779
Name:LAWRENCE EYE CARE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:LAWRENCE EYE CARE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-841-2280
Mailing Address - Street 1:1015 IOWA STREET
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1838
Mailing Address - Country:US
Mailing Address - Phone:785-841-2280
Mailing Address - Fax:785-841-2765
Practice Address - Street 1:1015 IOWA STREET
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1838
Practice Address - Country:US
Practice Address - Phone:785-841-2280
Practice Address - Fax:785-841-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1013780001Medicare NSC
016353Medicare ID - Type Unspecified