Provider Demographics
NPI:1396895009
Name:LAWRENCE FAMILY VISION CLINIC P A
Entity type:Organization
Organization Name:LAWRENCE FAMILY VISION CLINIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONE-SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-749-2020
Mailing Address - Street 1:3111 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3101
Mailing Address - Country:US
Mailing Address - Phone:785-749-2020
Mailing Address - Fax:785-749-2323
Practice Address - Street 1:3111 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3101
Practice Address - Country:US
Practice Address - Phone:785-749-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0776480001Medicare NSC
KS005345Medicare PIN