Provider Demographics
NPI:1104894500
Name:FLORES, ROMERO R (OD)
Entity type:Individual
Prefix:DR
First Name:ROMERO
Middle Name:R
Last Name:FLORES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1320 14TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4348
Mailing Address - Country:US
Mailing Address - Phone:256-734-8514
Mailing Address - Fax:256-734-8392
Practice Address - Street 1:601A GRAHAM ST SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5298
Practice Address - Country:US
Practice Address - Phone:256-734-8514
Practice Address - Fax:256-734-8392
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSB06TA692152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51004423OtherBCBS
AL009940058Medicaid
V06741Medicare UPIN
AL51004423OtherBCBS