Healthcare Provider Details

I. General information

NPI: 1437216355
Provider Name (Legal Business Name): JASON BRATCHER OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N HUDSON ST
SILVER CITY NM
88061-5436
US

IV. Provider business mailing address

PO BOX 2329
SILVER CITY NM
88062-2329
US

V. Phone/Fax

Practice location:
  • Phone: 575-538-2994
  • Fax: 575-538-2996
Mailing address:
  • Phone: 575-538-2994
  • Fax: 575-538-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number568
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number568
License Number StateNM

VIII. Authorized Official

Name: DR. JASON ALLEN BRATCHER
Title or Position: OWNER
Credential: O.D.
Phone: 575-538-2994