Provider Demographics
NPI:1174576987
Name:COHEN, LAWRENCE SUMNER (OD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:SUMNER
Last Name:COHEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-3622
Mailing Address - Country:US
Mailing Address - Phone:508-336-1199
Mailing Address - Fax:508-923-9894
Practice Address - Street 1:620 GEORGE WASHINGTON HWY
Practice Address - Street 2:TARGET OPTICAL
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02864-4293
Practice Address - Country:US
Practice Address - Phone:401-642-0080
Practice Address - Fax:508-923-9894
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3586152W00000X
RICODTG00688152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110016321AMedicaid
MA0355976Medicaid
MA462158Medicare ID - Type Unspecified