Provider Demographics
NPI:1528134673
Name:WOLMETZ, LAWRENCE MITCHELL (LDO)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:MITCHELL
Last Name:WOLMETZ
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10156 LEXINGTON ESTATES BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4256
Mailing Address - Country:US
Mailing Address - Phone:561-477-9955
Mailing Address - Fax:561-470-3601
Practice Address - Street 1:3986 NW 19TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33311-4126
Practice Address - Country:US
Practice Address - Phone:954-735-4060
Practice Address - Fax:954-735-6099
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1058156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0954180001Medicare ID - Type UnspecifiedPROVIDER NUMBER