Provider Demographics
NPI:1790889723
Name:LAZARUS, STUART M (OD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:M
Last Name:LAZARUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:58 HUNTERSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-3820
Mailing Address - Country:US
Mailing Address - Phone:518-439-2071
Mailing Address - Fax:518-439-2071
Practice Address - Street 1:58 HUNTERSFIELD RD
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-3820
Practice Address - Country:US
Practice Address - Phone:518-439-2071
Practice Address - Fax:518-439-2071
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTU003017-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT26526Medicare UPIN
NY50560BMedicare ID - Type Unspecified