Individual
MIRIAM J LAVELLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
917 RIDGE RD, ROXBORO, NC 27573-4511
(336) 599-0138
(336) 599-0080
Mailing address
917 RIDGE RD, ROXBORO, NC 27573-4511
(336) 599-0138
(336) 599-0080
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
NC1282
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0204C
BCBS
NC
05
—
89-0919F
—
NC
Enumeration date
07/26/2005
Last updated
01/28/2013
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