Provider Demographics
NPI:1053118273
Name:L A RUNNERSTROM OD PLLC
Entity type:Organization
Organization Name:L A RUNNERSTROM OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ AUTHORIZED OFFICAL
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNNERSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:518-479-3306
Mailing Address - Street 1:749 COLUMBIA TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2612
Mailing Address - Country:US
Mailing Address - Phone:518-479-3306
Mailing Address - Fax:518-479-4502
Practice Address - Street 1:749 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2612
Practice Address - Country:US
Practice Address - Phone:518-479-3306
Practice Address - Fax:518-479-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty