Provider Demographics
NPI:1295080596
Name:LAWRENCE, LATASHA (OD)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SPRINGFIELD AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1277
Mailing Address - Country:US
Mailing Address - Phone:908-336-5660
Mailing Address - Fax:
Practice Address - Street 1:2384 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1703
Practice Address - Country:US
Practice Address - Phone:212-724-0850
Practice Address - Fax:212-580-5062
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00640600152W00000X
NY007925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist