Healthcare Provider Details

I. General information

NPI: 1649384710
Provider Name (Legal Business Name): PAUL A. TACHAU O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 LUISA ST SUITE D
SANTA FE NM
87505-7002
US

IV. Provider business mailing address

1409 LUISA ST SUITE D
SANTA FE NM
87505-7002
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-8989
  • Fax: 505-984-8892
Mailing address:
  • Phone: 505-984-8989
  • Fax: 505-984-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number325
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: