Provider Demographics
NPI:1720264724
Name:LAZZARA, MATTHEW DENNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DENNIS
Last Name:LAZZARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 N CLEVELAND AVE
Mailing Address - Street 2:APT 3F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3766
Mailing Address - Country:US
Mailing Address - Phone:202-498-5921
Mailing Address - Fax:
Practice Address - Street 1:2252 N CLEVELAND AVE
Practice Address - Street 2:APT 3F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3766
Practice Address - Country:US
Practice Address - Phone:202-498-5921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology