Provider Demographics
NPI:1710174081
Name:TOM, LAUREN A (OD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:TOM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:A
Other - Last Name:HULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1422 N LOOP 336 W STE B
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3540
Mailing Address - Country:US
Mailing Address - Phone:936-539-2020
Mailing Address - Fax:936-756-7916
Practice Address - Street 1:1422 N LOOP 336 W STE B
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3540
Practice Address - Country:US
Practice Address - Phone:936-539-2020
Practice Address - Fax:936-756-7916
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13370152W00000X
TX7168TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L19956Medicare PIN