Provider Demographics
NPI:1487703203
Name:LAUER, AMY L (OD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:LAUER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5563 EARLIGLOW LN
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-9766
Mailing Address - Country:US
Mailing Address - Phone:517-974-8683
Mailing Address - Fax:
Practice Address - Street 1:1982 W GRAND RIVER AVE
Practice Address - Street 2:#815
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1736
Practice Address - Country:US
Practice Address - Phone:517-349-0784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004239152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU92833Medicare UPIN
MIN34040019Medicare ID - Type Unspecified