Provider Demographics
NPI:1811164239
Name:LAWSON, VICKY LEA (OPTICAN)
Entity type:Individual
Prefix:MS
First Name:VICKY
Middle Name:LEA
Last Name:LAWSON
Suffix:
Gender:F
Credentials:OPTICAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BESS BLVD
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-8804
Mailing Address - Country:US
Mailing Address - Phone:765-644-2541
Mailing Address - Fax:765-644-0608
Practice Address - Street 1:1503 REV JT MENIFEE STREET
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016
Practice Address - Country:US
Practice Address - Phone:765-644-2541
Practice Address - Fax:765-644-0608
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1392OtherOP