Provider Demographics
NPI:1306129630
Name:ROMAN ROBLES, LYDIA M (OD)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:M
Last Name:ROMAN ROBLES
Suffix:
Gender:F
Credentials:OD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3423
Mailing Address - Street 2:BAYAMON, GARDENS STA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-0423
Mailing Address - Country:US
Mailing Address - Phone:787-787-4036
Mailing Address - Fax:787-780-2118
Practice Address - Street 1:SAN FERNANDO
Practice Address - Street 2:E-18 AVE HERMANAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-1769
Practice Address - Country:US
Practice Address - Phone:787-787-4036
Practice Address - Fax:787-780-2118
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR688152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR688OtherSTATE LIC #