Provider Demographics
NPI:1730123027
Name:FROMM, LAWRENCE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:FROMM
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 1:601 E WHITTIER BLVD
Mailing Address - Street 2:102
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3972
Mailing Address - Country:US
Mailing Address - Phone:562-697-6733
Mailing Address - Fax:562-697-8303
Practice Address - Street 1:601 E WHITTIER BLVD
Practice Address - Street 2:102
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3972
Practice Address - Country:US
Practice Address - Phone:562-697-6733
Practice Address - Fax:562-697-8303
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4497T152W00000X
CA4497 T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4497TOtherLICENSE
CASD0044971Medicaid
4497Medicare ID - Type Unspecified
T69907Medicare UPIN