Provider Demographics
NPI:1699812263
Name:LAVAUX, JOSEPH ELWOOD (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ELWOOD
Last Name:LAVAUX
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 ELKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN HAVEN
Mailing Address - State:CO
Mailing Address - Zip Code:80532-0162
Mailing Address - Country:US
Mailing Address - Phone:970-577-1612
Mailing Address - Fax:
Practice Address - Street 1:959 ELKRIDGE DR
Practice Address - Street 2:
Practice Address - City:GLEN HAVEN
Practice Address - State:CO
Practice Address - Zip Code:80532-0162
Practice Address - Country:US
Practice Address - Phone:970-577-1612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist