Provider Demographics
NPI:1730109216
Name:LAZARTE, RICHARD C (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:LAZARTE
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 1:5488 S PADRE ISLAND DR STE 2042
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4122
Mailing Address - Country:US
Mailing Address - Phone:361-994-0310
Mailing Address - Fax:361-257-1314
Practice Address - Street 1:5488 S PADRE ISLAND DR STE 2042
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4122
Practice Address - Country:US
Practice Address - Phone:361-994-0310
Practice Address - Fax:361-994-0452
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2505TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0933103-01Medicaid
TX00E56DMedicare ID - Type Unspecified
TX0933103-01Medicaid