Basic Information
| Provider Information | |||||||||
| NPI: | 1598735680 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYLVESTER | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 494 GATEWAY AVE. | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172017351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172636186 | ||||||||
| FaxNumber: | 7172636888 | ||||||||
| Practice Location | |||||||||
| Address1: | 494 GATEWAY AVE. | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172017351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172636186 | ||||||||
| FaxNumber: | 7172636888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 11/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OEG000954 | PA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0013062010001 | 05 | PA | MEDICAID |