Provider Demographics
NPI:1457427510
Name:LAVOIE, WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:LAVOIE
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 1:1020 BEAUMARIS WAY
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2387
Mailing Address - Country:US
Mailing Address - Phone:772-231-9177
Mailing Address - Fax:772-231-9177
Practice Address - Street 1:1020 BEAUMARIS WAY
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-2387
Practice Address - Country:US
Practice Address - Phone:772-231-9177
Practice Address - Fax:772-231-9177
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001481152WC0802X
CT873152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620509700Medicaid
FLE4487Medicare ID - Type UnspecifiedPROVIDER NUMBER