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General NPI Number Information
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NPI Number | 1609889310
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Entity Type | Individual
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Provider Name | DEIDRA MARIE CASAUS O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 12/20/2016
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Provider Practice Location Address
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Address Line | 160 S CAMINO DEL PUEBLO STE E
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City | BERNALILLO
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State | NM
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Zip | 87004-6173
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Country | US
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Telephone | 505-771-3937
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Fax | 505-771-1282
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Provider Business Mailing Address
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Address Line | 3566 WHITE HORSE DR SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-3676
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Country | US
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Telephone | 505-771-3937
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Fax | 505-771-1282
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 408
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License Number State | NM
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