Provider Demographics
NPI:1760587661
Name:LAWRENCE A. SHAFRON MD PA
Entity Type:Organization
Organization Name:LAWRENCE A. SHAFRON MD PA
Other - Org Name:ADVANCED EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:SHAFRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-382-8000
Mailing Address - Street 1:2210 SAN JACINTO BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7527
Mailing Address - Country:US
Mailing Address - Phone:940-382-8000
Mailing Address - Fax:940-383-2608
Practice Address - Street 1:2210 SAN JACINTO BLVD STE 1
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7531
Practice Address - Country:US
Practice Address - Phone:940-382-8000
Practice Address - Fax:940-383-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AK441OtherBCBS PIN
TX00H06ZMedicare PIN
TX8AK441OtherBCBS PIN