Provider Demographics
NPI:1689630600
Name:LAVESON, JOEL WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:WILLIAM
Last Name:LAVESON
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 1:1305 CHESTERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3419
Mailing Address - Country:US
Mailing Address - Phone:609-504-8577
Mailing Address - Fax:
Practice Address - Street 1:508 S BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1250
Practice Address - Country:US
Practice Address - Phone:856-541-6131
Practice Address - Fax:856-541-0241
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA002762152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223312478OtherCORPORATE OFFICE
NJ2158400Medicaid
NJ010577064OtherCORPORATE OFFICE
NJ010577064OtherCORPORATE OFFICE