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General NPI Number Information
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NPI Number | 1053118273
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Entity Type | Organization
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Legal Business Name | LA RUNNERSTROM OD PLLC
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 749 COLUMBIA TPKE
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City | EAST GREENBUSH
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State | NY
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Zip | 12061-2612
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Country | US
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Telephone | 518-479-3306
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Fax | 518-479-4502
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Provider Business Mailing Address
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Address Line | 749 COLUMBIA TPKE
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City | EAST GREENBUSH
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State | NY
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Zip | 12061-2612
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Country | US
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Telephone | 518-479-3306
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Fax | 518-479-4502
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Authorized Official
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Title or Position | OWNER/ AUTHORIZED OFFICAL
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Name | DR. LAURIE RUNNERSTROM
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Credential | OD
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Telephone | 518-479-3306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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