MEDICARE: MS. RENEE ANNETTE FUEMMELER OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	NM2525	NM

General Provider Information

NPI Number	:	1508944737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENEE ANNETTE FUEMMELER OD

Provider Business Mailing Address
First Line	:	7121 PROSPECT PL NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4313
Country	:	US
Telephone Number	:	505-293-3515
Fax Number	:

Provider Business Practice Location Address
First Line	:	7121 PROSPECT PL NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4313
Country	:	US
Telephone Number	:	505-293-3515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	12/30/2011

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