Provider Demographics
NPI:1477657419
Name:CAMARILLO, VERONICA M (OD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:M
Last Name:CAMARILLO
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 1:1330 W 4TH PL
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-4918
Mailing Address - Country:US
Mailing Address - Phone:219-973-3712
Mailing Address - Fax:
Practice Address - Street 1:6050 US HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5047
Practice Address - Country:US
Practice Address - Phone:219-762-7862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003266A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist