Provider Demographics
NPI:1760902860
Name:LAVENDER, HILLARY ALYSSA (OD)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:ALYSSA
Last Name:LAVENDER
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 1:4109 N MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3500
Mailing Address - Country:US
Mailing Address - Phone:432-694-5259
Mailing Address - Fax:432-697-3815
Practice Address - Street 1:4109 N MIDLAND DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3500
Practice Address - Country:US
Practice Address - Phone:432-694-5259
Practice Address - Fax:432-697-3815
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9101T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist