Healthcare Provider Details

I. General information

NPI: 1871585687
Provider Name (Legal Business Name): ROMIE SUE LAVOIE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ROMIE MILLER O.D.

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 WYOMING BLVD NE
ALBUQUERQUE NM
87112-1154
US

IV. Provider business mailing address

2433 WYOMING BLVD NE
ALBUQUERQUE NM
87112-1154
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 Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOP2498
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: