Individual
KENNETH E LAWRENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
216 E MARKET ST, LOGANSPORT, IN 46947-3430
(574) 753-2559
(574) 722-4926
Mailing address
PO BOX 269, LOGANSPORT, IN 46947-0269
(574) 753-2559
(574) 722-4926
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001980B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000085953
BCBS
IN
05
—
100070790
—
IN
Enumeration date
08/24/2005
Last updated
11/01/2012
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