Provider Demographics
NPI:1780679696
Name:LAWSON, TERRY LARMON (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LARMON
Last Name:LAWSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:9102 S TOLEDO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2700
Mailing Address - Country:US
Mailing Address - Phone:918-742-2055
Mailing Address - Fax:918-742-0991
Practice Address - Street 1:9102 S TOLEDO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2700
Practice Address - Country:US
Practice Address - Phone:918-742-2055
Practice Address - Fax:918-742-0991
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2009-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1165152WC0802X, 152W00000X, 152WL0500X, 152WX0102X, 152WP0200X, 152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763750AMedicaid
OKOK700497Medicare PIN
OK100763750AMedicaid
OK5466550001Medicare NSC