Provider Demographics
NPI:1306996269
Name:LAZEROW, BRUCE LEE (BA, BS, OD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LEE
Last Name:LAZEROW
Suffix:
Gender:M
Credentials:BA, BS, OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 OAKENSHIELD DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2928
Mailing Address - Country:US
Mailing Address - Phone:301-340-7674
Mailing Address - Fax:301-593-7006
Practice Address - Street 1:2612 OAKENSHIELD DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2928
Practice Address - Country:US
Practice Address - Phone:301-340-7674
Practice Address - Fax:301-593-7006
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDA-0688152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU35508Medicare UPIN