Provider Demographics
NPI:1487751939
Name:LAMOREUX, ROGER S (OD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:S
Last Name:LAMOREUX
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 1:1334 N 4TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-2106
Mailing Address - Country:US
Mailing Address - Phone:715-224-2200
Mailing Address - Fax:
Practice Address - Street 1:1334 N 4TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487
Practice Address - Country:US
Practice Address - Phone:715-224-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1542-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38507400Medicaid
WI38507400Medicaid
WI000047338Medicare ID - Type Unspecified