Provider Demographics
NPI:1780709840
Name:LAPP, CAMERON LAYTON (OD)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:LAYTON
Last Name:LAPP
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 1:1717 HIDDEN OAKS CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-1651
Mailing Address - Country:US
Mailing Address - Phone:815-577-6448
Mailing Address - Fax:
Practice Address - Street 1:585 RIVER OAKS W
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5443
Practice Address - Country:US
Practice Address - Phone:219-924-9714
Practice Address - Fax:219-924-9714
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009301152W00000X
IN18003332A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU86899Medicare UPIN
ILU86899Medicare UPIN