Provider Demographics
NPI:1154591097
Name:LAWRENCE A. STRANCH
Entity type:Organization
Organization Name:LAWRENCE A. STRANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-364-7793
Mailing Address - Street 1:PO BOX F
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-0300
Mailing Address - Country:US
Mailing Address - Phone:386-364-7793
Mailing Address - Fax:
Practice Address - Street 1:522 OHIO AVE S
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-3219
Practice Address - Country:US
Practice Address - Phone:386-364-7793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 000767332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0673010001Medicare NSC