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Organization
CHARLES P. LAWLESS, M.D., P.A.
Active
Organization
CHARLES P. LAWLESS, M.D., P.A.
Active
Other names
WALT'S OPTICAL SHOP
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES PITTMAN LAWLESS M.D. (PRESIDENT)
(208) 232-4133
Entity
Organization
Contact information
Practice address
1777 E CLARK ST STE 310, POCATELLO, ID 83201-3357
(208) 232-4133
(208) 233-5736
Mailing address
1777 E CLARK ST STE 310, POCATELLO, ID 83201-3357
(208) 232-4133
(208) 233-5736
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M-3434
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005308
REGENCE BLUE SHIELD OF ID
ID
01
—
07302
BLUE CROSS OF IDAHO
ID
Enumeration date
05/04/2007
Last updated
12/03/2007
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