Provider Demographics
NPI:1881804300
Name:RICHARD, LAWRENCE EDWIN
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:EDWIN
Last Name:RICHARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8096 RIVERS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9243
Mailing Address - Country:US
Mailing Address - Phone:843-818-2020
Mailing Address - Fax:843-818-2379
Practice Address - Street 1:8096 RIVERS AVE STE A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9243
Practice Address - Country:US
Practice Address - Phone:843-818-2020
Practice Address - Fax:843-818-2379
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC905156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician