Provider Demographics
NPI:1710305206
Name:KAUFFMAN, LAWRENCE
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:KAUFFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W ROUTE 38
Mailing Address - Street 2:STORE 1400
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3219
Mailing Address - Country:US
Mailing Address - Phone:856-234-2020
Mailing Address - Fax:856-234-4332
Practice Address - Street 1:400 W ROUTE 38
Practice Address - Street 2:STORE 1400
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3219
Practice Address - Country:US
Practice Address - Phone:856-234-2020
Practice Address - Fax:856-234-4332
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00312400156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician