Healthcare Provider Details

I. General information

NPI: 1891298030
Provider Name (Legal Business Name): MICHAEL D. HERRERA, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 CERRILLOS RD STE 103
SANTA FE NM
87507-4112
US

IV. Provider business mailing address

4 RUSTY SPUR PL
SANTA FE NM
87508-1350
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-9600
  • Fax: 505-438-5014
Mailing address:
  • Phone: 505-429-0809
  • Fax: 505-438-8100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JENEANE M HERRERA
Title or Position: BUSINESS MANAGER
Credential:
Phone: 505-428-0809