Provider Demographics
NPI:1689406068
Name:KAZZAZI, LAWRENCE (OD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:KAZZAZI
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 1:3451 S DOGWOOD RD STE 1334
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-9140
Mailing Address - Country:US
Mailing Address - Phone:760-336-3003
Mailing Address - Fax:
Practice Address - Street 1:3451 S DOGWOOD RD STE 1334
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9140
Practice Address - Country:US
Practice Address - Phone:760-336-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist