Provider Demographics
NPI:1760867246
Name:CRUZ, LAWRENCE-STUART MICIANO (OD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE-STUART
Middle Name:MICIANO
Last Name:CRUZ
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 1:2215 S LOOP 288 STE 334
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-4984
Mailing Address - Country:US
Mailing Address - Phone:940-484-7258
Mailing Address - Fax:
Practice Address - Street 1:2215 S LOOP 288 STE 334
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-4984
Practice Address - Country:US
Practice Address - Phone:940-484-7258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15353152W00000X
NV958152W00000X
TX11154152W00000X
WAOD60589484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist