1134248479 NPI number — JAMES H DUDEN

Table of content: (NPI 1134248479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134248479 NPI number — JAMES H DUDEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES H DUDEN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OPTICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134248479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 NORTH MAIN ST
Provider Second Line Business Mailing Address:
SUITE 9
Provider Business Mailing Address City Name:
CLOVIS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-762-5266
Provider Business Mailing Address Fax Number:
505-762-5266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 NORTH MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
CLOVIS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-762-5266
Provider Business Practice Location Address Fax Number:
505-762-5266
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUDEN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
505-762-5266

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39726 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: NM0094 . This is a "EYE MED VISION CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P8824 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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