Individual
BENJAMIN LAWLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1617 N WEST AVE, JACKSON, MI 49202-2030
(517) 780-3828
(517) 780-4959
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901005242
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194879023
—
MI
Enumeration date
06/05/2019
Last updated
04/09/2021
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