Provider Demographics
NPI:1023081247
Name:FORUR, LAWRENCE (OD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:FORUR
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 1:150 ISLIP AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3222
Mailing Address - Country:US
Mailing Address - Phone:631-491-6248
Mailing Address - Fax:631-581-7512
Practice Address - Street 1:150 ISLIP AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3222
Practice Address - Country:US
Practice Address - Phone:631-581-5100
Practice Address - Fax:631-581-7512
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00887274Medicaid
NY0351440001Medicare NSC
NYC40401Medicare PIN
NY00887274Medicaid
NYA400051633Medicare PIN