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General NPI Number Information
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NPI Number | 1437179322
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Entity Type | Individual
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Provider Name | LAMONT ROBERSON OD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 125 N. 2ND AVE
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City | EVANSTON
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State | WY
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Zip | 82930
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Country | US
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Telephone | 307-789-9573
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1583
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City | THAYNE
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State | WY
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Zip | 83127-1583
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Country | US
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Telephone | 307-883-8583
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 302T
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License Number State | WY
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