Active NPI
Bruce Lee Lazerow, B.A., B.S., O.D.
- Optometrist
- Potomac, MD
National Provider Identifier
1306996269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- DA-0688
- Practice address
- 2612 Oakenshield Dr
Potomac, MD 20854-2928 - Phone
- (301) 340-7674
- Fax
- (301) 593-7006
- NPI assigned
- Jan 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | DA-0688 | MD | Primary |
Addresses
Primary practice location
2612 Oakenshield Dr
Potomac, MD 20854-2928
Mailing address
2612 Oakenshield Dr
Potomac, MD 20854-2928
Phone (301) 340-7674
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160209000078 | DC | Practitioner - Optometry | 1557665718 | Practice locations: Washington, DC |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Bachelor of Arts, Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DA-0688 | MD | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1306996269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2612 OAKENSHIELD DR",
"city": "POTOMAC",
"state": "MD",
"postal_code": "208542928",
"telephone_number": "301-340-7674",
"fax_number": "301-593-7006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2612 OAKENSHIELD DR",
"city": "POTOMAC",
"state": "MD",
"postal_code": "208542928",
"telephone_number": "301-340-7674",
"fax_number": "301-593-7006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAZEROW",
"first_name": "BRUCE",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "B.A., B.S., O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MD",
"license": "DA-0688",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Potomac, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.