Provider Demographics
NPI:1063411635
Name:LAZARUS, HOWARD S (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:S
Last Name:LAZARUS
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 1:519 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-3620
Mailing Address - Country:US
Mailing Address - Phone:812-948-0616
Mailing Address - Fax:812-949-3447
Practice Address - Street 1:519 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-3620
Practice Address - Country:US
Practice Address - Phone:812-948-0616
Practice Address - Fax:812-949-3447
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044244A207W00000X, 207WX0107X
KY31665207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1056446Medicaid
IN200041730Medicaid
KY000000042613OtherANTHEM
KY2433871000Medicaid
KY64878846Medicaid
IN180021732Medicare ID - Type UnspecifiedRAILROAD MEDICARE INDIANA
KY00132001Medicare ID - Type Unspecified
F35170Medicare UPIN
KY180039104Medicare ID - Type UnspecifiedRAILROAD MEDICARE KENTUCK
KY2433871000Medicaid