Provider Demographics
NPI:1396945218
Name:CHARLES D LAWLER, O.D.
Entity type:Organization
Organization Name:CHARLES D LAWLER, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LAWLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-968-5225
Mailing Address - Street 1:369 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-2096
Mailing Address - Country:US
Mailing Address - Phone:731-967-3291
Mailing Address - Fax:
Practice Address - Street 1:369 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-2096
Practice Address - Country:US
Practice Address - Phone:731-967-3291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT455152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0157200001Medicare NSC
3941548Medicare PIN