Provider Demographics
NPI:1629566070
Name:LAZARUS, MATTHEW R (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:LAZARUS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:5311 CAROLINE DR
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-2481
Mailing Address - Country:US
Mailing Address - Phone:636-489-0133
Mailing Address - Fax:636-489-1403
Practice Address - Street 1:5311 CAROLINE DR
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-2481
Practice Address - Country:US
Practice Address - Phone:636-489-0133
Practice Address - Fax:636-489-1403
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2018021523152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist