Provider Demographics
NPI:1548747223
Name:O'NEAL, LAUREN DEVERAUX (OD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:DEVERAUX
Last Name:O'NEAL
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 1:9429 ALLANDE RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6617
Mailing Address - Country:US
Mailing Address - Phone:505-850-0583
Mailing Address - Fax:
Practice Address - Street 1:4250 CERRILLOS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4697
Practice Address - Country:US
Practice Address - Phone:505-438-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOPT701152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist