Provider Demographics
NPI:1699115980
Name:WOLITZER, LAUREN A (OD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:A
Last Name:WOLITZER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6228
Mailing Address - Country:US
Mailing Address - Phone:212-877-5840
Mailing Address - Fax:
Practice Address - Street 1:210 W 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6228
Practice Address - Country:US
Practice Address - Phone:212-877-5840
Practice Address - Fax:212-877-5841
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist