=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306852447
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANE ELLEN COMPTON O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 12/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 710 F SOUTH SANTA FE RD
-----------------------------------------------------
City | TAOS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-758-2205
-----------------------------------------------------
Fax | 575-751-7102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1867
-----------------------------------------------------
City | TAOS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87571-1867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-758-2205
-----------------------------------------------------
Fax | 575-751-7102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OP2316
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------