Provider Demographics
NPI:1427049568
Name:LAU, GARY J (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:LAU
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1371
Mailing Address - Country:US
Mailing Address - Phone:934-324-3937
Mailing Address - Fax:937-324-8943
Practice Address - Street 1:2330 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1371
Practice Address - Country:US
Practice Address - Phone:934-324-3937
Practice Address - Fax:937-324-8943
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-0585207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0557599Medicaid
0557919Medicare ID - Type Unspecified
OH0557599Medicaid
0557917Medicare ID - Type Unspecified
A15883Medicare UPIN
0557918Medicare ID - Type Unspecified
0894151Medicare ID - Type Unspecified