Provider Demographics
NPI:1750489001
Name:LAZENBY, LORRY WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:LORRY
Middle Name:WAYNE
Last Name:LAZENBY
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 1:2318 E 32ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4326
Mailing Address - Country:US
Mailing Address - Phone:417-206-0399
Mailing Address - Fax:417-206-0567
Practice Address - Street 1:2318 E 32ND ST STE A
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4326
Practice Address - Country:US
Practice Address - Phone:417-206-0399
Practice Address - Fax:417-206-0567
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2703152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200914664OtherTAX I.D. #