Provider Demographics
NPI:1861654394
Name:LAWRENCE M. IRENE, P.C.
Entity Type:Organization
Organization Name:LAWRENCE M. IRENE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:IRENE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-215-2633
Mailing Address - Street 1:5000 S ARIZONA MILLS CIR STE 165
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6417
Mailing Address - Country:US
Mailing Address - Phone:480-820-3813
Mailing Address - Fax:480-831-1856
Practice Address - Street 1:5000 S ARIZONA MILLS CIR STE 165
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6417
Practice Address - Country:US
Practice Address - Phone:480-820-3813
Practice Address - Fax:480-831-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ811152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty