Provider Demographics
NPI:1629450796
Name:LAU, PAUL (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LAU
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 1:8150 SW BARNES RD APT J208
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6379
Mailing Address - Country:US
Mailing Address - Phone:510-612-4966
Mailing Address - Fax:
Practice Address - Street 1:3205 SW CEDAR HILLS BLVD STE 9
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1347
Practice Address - Country:US
Practice Address - Phone:971-348-3178
Practice Address - Fax:503-350-3944
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3028152W00000X
TX8737T152W00000X
OR4609152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E63GOtherMEDICARE