1689711400 NPI number — EYE ASSOCIATES OF NEW MEXICO LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689711400 NPI number — EYE ASSOCIATES OF NEW MEXICO LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE ASSOCIATES OF NEW MEXICO LTD
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:
1689711400
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8801 HORIZON BLVD NE
Provider Second Line Business Mailing Address:
SUITE 360
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87113-1533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-828-4923
Provider Business Mailing Address Fax Number:
505-213-0103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1399 WEIMER RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
TAOS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87571-6340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-758-0621
Provider Business Practice Location Address Fax Number:
505-758-0622
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REIDY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
505-246-2622

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 47951 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH4370 . This is a "RAILROAD MEDICARE (RRB)" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: CN6728 . This is a "RAILROAD MEDICARE (RRB)" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: K5006 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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