Provider Demographics
NPI:1265415160
Name:LUPO, LAWRENCE (OD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:LUPO
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 1:2766 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3639
Mailing Address - Country:US
Mailing Address - Phone:516-826-2020
Mailing Address - Fax:
Practice Address - Street 1:2766 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3639
Practice Address - Country:US
Practice Address - Phone:516-826-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV3567152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2017415OtherUNITED HEALTHCARE
NYC196D1OtherEMPIRE
NY14704OtherAETNA
NY6500700OtherGHI
NY108145OtherVYTRA
NY2C6996OtherHEALTHNET
NYP1059206OtherOXFORD
NYUT003567OtherHIP
NY0407170001Medicare NSC
NYP1059206OtherOXFORD
NY2C6996OtherHEALTHNET
NY2017415OtherUNITED HEALTHCARE