1598029308 NPI number — VISIONWEST, INC.

Table of content: VERONICA RAE ANN SMITH RN, MSN, CNP (NPI 1316214760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598029308 NPI number — VISIONWEST, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISIONWEST, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1598029308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
499 CAMINO PINONES
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-7523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-984-8989
Provider Business Mailing Address Fax Number:
505-992-1069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1610 N RIVERSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESPANOLA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87532-8063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-747-0433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
THIBODEAUX
Authorized Official First Name:
DWIGHT
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST / OWNER
Authorized Official Telephone Number:
505-984-8989

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  NM300 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1962516039 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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