Provider Demographics
NPI:1730151804
Name:SHAPIRO, LAWRENCE G (OD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:G
Last Name:SHAPIRO
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 1:57 E MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3003
Mailing Address - Country:US
Mailing Address - Phone:973-533-1333
Mailing Address - Fax:
Practice Address - Street 1:57 E MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3003
Practice Address - Country:US
Practice Address - Phone:973-533-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00357200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0289809Medicaid
NJU26887Medicare UPIN
NJ0289809Medicaid