Provider Demographics
NPI:1457520793
Name:LAWRENCE, SHAWN MONTEAL (OD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MONTEAL
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 FALCON CREEK WAY
Mailing Address - Street 2:APT 104
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-0666
Mailing Address - Country:US
Mailing Address - Phone:757-265-7805
Mailing Address - Fax:
Practice Address - Street 1:4905 FALCON CREEK WAY
Practice Address - Street 2:APT 104
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-0666
Practice Address - Country:US
Practice Address - Phone:757-265-7805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001705152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist