Healthcare Provider Details

I. General information

NPI: 1942524152
Provider Name (Legal Business Name): YAMILE LUCIA VILLAR-ROMAGUERA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YAMILE VILLAR O.D.

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 N TATUM BLVD # A111
PHOENIX AZ
85032-7710
US

IV. Provider business mailing address

5621 E VOLTAIRE AVE
SCOTTSDALE AZ
85254-3729
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-7336
  • Fax: 480-701-8050
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3385
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC3385
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1854
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1854
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: