Provider Demographics
NPI:1649358607
Name:TAYLOR, LAWRENCE A (ABOC)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-1960
Mailing Address - Country:US
Mailing Address - Phone:319-462-4449
Mailing Address - Fax:319-462-4449
Practice Address - Street 1:126 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-1960
Practice Address - Country:US
Practice Address - Phone:319-462-4449
Practice Address - Fax:319-462-4449
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAABOC 8497156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5490290001Medicare ID - Type Unspecified