Provider Demographics
NPI:1780842336
Name:LAWRENCE L .STOCKER MD PC
Entity Type:Organization
Organization Name:LAWRENCE L .STOCKER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-737-6955
Mailing Address - Street 1:6010 W MAPLE RD
Mailing Address - Street 2:#200
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4406
Mailing Address - Country:US
Mailing Address - Phone:248-737-6955
Mailing Address - Fax:248-737-8759
Practice Address - Street 1:6010 W MAPLE RD
Practice Address - Street 2:#200
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4406
Practice Address - Country:US
Practice Address - Phone:248-737-6955
Practice Address - Fax:248-737-8759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301015492207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1806385211OtherBCBSM
MI0638521Medicare PIN
MIA76399Medicare UPIN