Provider Demographics
NPI:1871126656
Name:ROMERO, ALEXIS DIANE (OD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DIANE
Last Name:ROMERO
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 1:3077 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-2607
Mailing Address - Country:US
Mailing Address - Phone:520-234-3138
Mailing Address - Fax:
Practice Address - Street 1:4413 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3507
Practice Address - Country:US
Practice Address - Phone:520-322-2713
Practice Address - Fax:520-325-8300
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist