Provider Demographics
NPI:1477006971
Name:HOUSTON, ROMINA A (OD)
Entity Type:Individual
Prefix:
First Name:ROMINA
Middle Name:A
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5023 MUD LN STE 110
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2800
Mailing Address - Country:US
Mailing Address - Phone:502-964-9400
Mailing Address - Fax:502-964-1915
Practice Address - Street 1:5023 MUD LN STE 110
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-2800
Practice Address - Country:US
Practice Address - Phone:502-964-9400
Practice Address - Fax:502-964-1915
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2038DT152W00000X
IN18003995A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2038DTOtherOPTOMETRIC LICENSE
KYPENDINGMedicaid
KYPENDINGMedicaid
KYPENDINGMedicare PIN
KYPENDINGMedicaid
KY2038DTOtherOPTOMETRIC LICENSE