Provider Demographics
NPI:1629001441
Name:CONTI, LAURIE A (OD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:CONTI
Suffix:
Gender:F
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:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:NASSAU
Mailing Address - State:DE
Mailing Address - Zip Code:19969-0058
Mailing Address - Country:US
Mailing Address - Phone:302-684-2020
Mailing Address - Fax:302-684-2021
Practice Address - Street 1:28322 LEWES GEORGETOWN HWY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-3117
Practice Address - Country:US
Practice Address - Phone:302-684-2020
Practice Address - Fax:302-684-2021
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE13-0001310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DET83210Medicare UPIN
DE02128S05Medicare PIN