Provider Demographics
NPI:1770005217
Name:BALDERAS, LUIS WON (OD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:WON
Last Name:BALDERAS
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 1:35184 CENTRAL CITY PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-6215
Mailing Address - Country:US
Mailing Address - Phone:734-427-5200
Mailing Address - Fax:
Practice Address - Street 1:35184 CENTRAL CITY PKWY
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-6215
Practice Address - Country:US
Practice Address - Phone:734-427-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2017-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005078152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist