Healthcare Provider Details

I. General information

NPI: 1912297417
Provider Name (Legal Business Name): DR. MARK A RASMUSSEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 S SAINT FRANCIS DR
SANTA FE NM
87505-4038
US

IV. Provider business mailing address

1460 S SAINT FRANCIS DR
SANTA FE NM
87505-4038
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-7746
  • Fax: 505-983-6849
Mailing address:
  • Phone: 505-983-7746
  • Fax: 505-983-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number371
License Number StateNM

VIII. Authorized Official

Name: MR. MARK A RASMUDDEN
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 505-983-7746