Individual
LUIS A DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2400 MORTHLAND DR, VALPARAISO, IN 46383-8329
(219) 465-2788
Mailing address
11917 W 107TH PL, SAINT JOHN, IN 46373-8868
(219) 552-4756
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
18003313
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200485370
—
IN
Enumeration date
08/30/2006
Last updated
07/08/2007
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