Provider Demographics
NPI:1598735680
Name:SYLVESTER, LAWRENCE J (OD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:SYLVESTER
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 1:494 GATEWAY AVE.
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-7351
Mailing Address - Country:US
Mailing Address - Phone:717-263-6186
Mailing Address - Fax:717-263-6888
Practice Address - Street 1:494 GATEWAY AVE.
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-7351
Practice Address - Country:US
Practice Address - Phone:717-263-6186
Practice Address - Fax:717-263-6888
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000954152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013062010001Medicaid
PAU10728Medicare UPIN
PA147166Medicare PIN