Provider Demographics
NPI:1689656712
Name:LAX, DAVID J (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:LAX
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 1:1700 WHITEHORSE HAMILTON SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3536
Mailing Address - Country:US
Mailing Address - Phone:609-587-2020
Mailing Address - Fax:609-588-9545
Practice Address - Street 1:1700 WHITEHORSE HAMILTON SQUARE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-3536
Practice Address - Country:US
Practice Address - Phone:609-587-2020
Practice Address - Fax:609-588-9545
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00368900152W00000X
NJ27T000071700152WV0400X
NJ27OA00368900156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0077327000OtherAMERIHEALTH
NJ3689OtherEYEMED
1156328OtherHORIZON NJ HEALTH
NJ0990108Medicaid
25425OtherMASTERCARE
51954OtherDAVIS VISION
1K9897OtherHEALTHNET
2022717OtherAETNA
47358OtherUNITED HEALTHCARE
334894OtherONE HEALTH PLAN
C52151OtherWELLCHOICE
P913877OtherOXFORD
0077327000OtherKEYSTONE
U54385Medicare UPIN
NJ0990108Medicaid
NJ080889CJPMedicare PIN