Provider Demographics
NPI:1992797708
Name:LAVOIE, ROBERT LIONEL (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LIONEL
Last Name:LAVOIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8000 PASEO DEL NORTE NE
Mailing Address - Street 2:BUILDING E
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2983
Mailing Address - Country:US
Mailing Address - Phone:505-291-1711
Mailing Address - Fax:505-298-0934
Practice Address - Street 1:8000 PASEO DEL NORTE NE
Practice Address - Street 2:BUILDING E
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2983
Practice Address - Country:US
Practice Address - Phone:505-291-1711
Practice Address - Fax:505-298-0934
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOP2499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM72616Medicaid
NM72616Medicaid