Provider Demographics
NPI:1952634206
Name:ROMAN, LUIS FELIPE (DO)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:FELIPE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:335 W PONCE DE LEON AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2451
Mailing Address - Country:US
Mailing Address - Phone:404-377-3937
Mailing Address - Fax:404-377-3936
Practice Address - Street 1:335 W PONCE DE LEON AVE
Practice Address - Street 2:SUITE F
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2451
Practice Address - Country:US
Practice Address - Phone:404-377-3937
Practice Address - Fax:404-377-3936
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO 002182156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician