1972820488 NPI number — LOS ALAMOS FAMILY EYECARE, P.C.

Table of content: MRS. SHANNON DELYNN ASHFORD R.N. (NPI 1255366159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972820488 NPI number — LOS ALAMOS FAMILY EYECARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS ALAMOS FAMILY EYECARE, P.C.
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:
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:
1972820488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 TRINITY DR. STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ALAMOS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 TRINITY DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ALAMOS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87544-4105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-662-9681
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SHIN
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
O.D.
Authorized Official Telephone Number:
505-662-9681

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  NM476 , 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)





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