Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic |
NPI | 1578539524 |
---|---|
Provider Name | Robert J Lazorik |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 28/04/2009 |