Healthcare Provider Details

I. General information

NPI: 1871796201
Provider Name (Legal Business Name): JAY S. FOLKMAN OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6821 MONTGOMERY BLVD NE STE C
ALBUQUERQUE NM
87109-1410
US

IV. Provider business mailing address

6821 MONTGOMERY BLVD NE STE C
ALBUQUERQUE NM
87109-1444
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-7440
  • Fax: 505-837-2117
Mailing address:
  • Phone: 505-881-7440
  • Fax: 505-837-2117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP2294
License Number StateNM

VIII. Authorized Official

Name: DR. JAY S FOLKMAN
Title or Position: OPTOMETRIST
Credential: O.D.P.C
Phone: 505-881-7440