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General NPI Number Information
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NPI Number | 1942471974
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Entity Type | Organization
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Legal Business Name | ROBERT L DORAZIO OD
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 225 NIZHONI BLVD
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City | GALLUP
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State | NM
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Zip | 87301-5792
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Country | US
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Telephone | 505-863-5747
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Fax | 505-863-5101
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Provider Business Mailing Address
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Address Line | 225 NIZHONI BLVD
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City | GALLUP
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State | NM
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Zip | 87301-5792
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Country | US
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Telephone | 505-863-5747
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Fax | 505-863-5101
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | ROBERT L DORAZIO
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Credential | OD
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Telephone | 505-863-5747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 328
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License Number State | NM
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