Healthcare Provider Details

I. General information

NPI: 1790790160
Provider Name (Legal Business Name): JASON ALLEN BRATCHER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 11/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611N HUDSON ST
SILVER CITY NM
88061-5436
US

IV. Provider business mailing address

611N HUDSON ST
SILVER CITY NM
88061-5436
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 TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number568
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number568
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: