Provider Demographics
NPI:1205065000
Name:LAWSON, LARRY (DO)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:LAWSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4153
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06147-4153
Mailing Address - Country:US
Mailing Address - Phone:860-635-4600
Mailing Address - Fax:860-635-4650
Practice Address - Street 1:51 SHUNPIKE RD
Practice Address - Street 2:SUITE 29
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2497
Practice Address - Country:US
Practice Address - Phone:860-635-4600
Practice Address - Fax:860-635-4650
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT1402156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician