Individual
DR. DEREK BRIAN LAURITZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
941 CALIFORNIA BLVD, SAN LUIS OBISPO, CA 93401
(805) 434-2350
(805) 434-9888
Mailing address
941 CALIFORNIA BLVD, SAN LUIS OBISPO, CA 93401-2905
(805) 544-0006
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
G77319
CA
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
G77319
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G773190
BLUE SHIELD OF CALIFORNIA
CA
05
—
00G773190
—
CA
01
—
7808216
AETNA PIN
CA
01
—
G77319
BLUE CROSS
CA
Enumeration date
01/05/2007
Last updated
03/24/2025
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