Healthcare Provider Details

I. General information

NPI: 1992797708
Provider Name (Legal Business Name): ROBERT LIONEL LAVOIE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 PASEO DEL NORTE NE BUILDING E
ALBUQUERQUE NM
87122-2983
US

IV. Provider business mailing address

8000 PASEO DEL NORTE NE BUILDING E
ALBUQUERQUE NM
87122-2983
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-1711
  • Fax: 505-298-0934
Mailing address:
  • Phone: 505-291-1711
  • Fax: 505-298-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP2499
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: