Provider Demographics
NPI:1942471974
Name:ROBERT L DORAZIO OD
Entity Type:Organization
Organization Name:ROBERT L DORAZIO OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DORAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-863-5747
Mailing Address - Street 1:225 NIZHONI BLVD
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5792
Mailing Address - Country:US
Mailing Address - Phone:505-863-5747
Mailing Address - Fax:505-863-5101
Practice Address - Street 1:225 NIZHONI BLVD
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5792
Practice Address - Country:US
Practice Address - Phone:505-863-5747
Practice Address - Fax:505-863-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM328332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0190290001Medicare NSC
NM00190290001Medicare UPIN