Healthcare Provider Details

I. General information

NPI: 1184465056
Provider Name (Legal Business Name): DREW CASEY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 MENAUL BLVD NE
ALBUQUERQUE NM
87112-2231
US

IV. Provider business mailing address

3114 TESS CT NE
RIO RANCHO NM
87144-1473
US

V. Phone/Fax

Practice location:
  • Phone: 505-219-3113
  • Fax: 505-792-6608
Mailing address:
  • Phone: 614-456-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-2024-0009
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: