Provider Demographics
NPI:1952313777
Name:HADDAD, LAWRENCE FUAD (OD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:FUAD
Last Name:HADDAD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16771 TORRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-6018
Mailing Address - Country:US
Mailing Address - Phone:708-474-9369
Mailing Address - Fax:708-474-9373
Practice Address - Street 1:16771 TORRENCE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-6018
Practice Address - Country:US
Practice Address - Phone:708-474-9369
Practice Address - Fax:708-474-9373
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009114152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist