Provider Demographics
NPI:1982606836
Name:WOLIN, LAWRENCE DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:DAVID
Last Name:WOLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 W CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2407
Mailing Address - Country:US
Mailing Address - Phone:847-255-3515
Mailing Address - Fax:847-255-8727
Practice Address - Street 1:1602 W CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2407
Practice Address - Country:US
Practice Address - Phone:847-255-3515
Practice Address - Fax:847-255-8727
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059451207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2599030001OtherDMERC
IL1623380OtherBCBS
IL036059451Medicaid
IL180037165OtherMEDICARE RAILROAD
IL1623380OtherBCBS
IL535000Medicare PIN