Provider Demographics
NPI:1972555167
Name:ERNST, LAWRENCE WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:WILLIAM
Last Name:ERNST
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 1:277 WEST VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-1211
Mailing Address - Country:US
Mailing Address - Phone:636-456-2020
Mailing Address - Fax:
Practice Address - Street 1:277 WEST VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-1211
Practice Address - Country:US
Practice Address - Phone:636-456-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO317810505Medicaid
MOU31093Medicare UPIN
MO000008435Medicare PIN
MO317810505Medicaid