Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 659 | VA |
NPI | 1376551119 |
---|---|
Provider Name | Mr. Lawrence Howard Bauer |
First Address | Alexandria, VA 22302-1215 |
Second Address | Alexandria, VA 22302-1215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 05/02/2008 |