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NPI Code Detail

MEDICARE: ROBERT RATZLAFF OD LLC

MEDICARE: ROBERT RATZLAFF OD LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist474NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316024185
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT RATZLAFF OD LLC
Provider Business Mailing Address
First Line : 1128-A PASEO DEL PUEBLO SUR
Second Line : 7653 NDCBU
City : TAOS
State : NM
Zip : 87571
Country : US
Telephone Number : 505-758-3215
Fax Number : 505-751-9280
Provider Business Practice Location Address
First Line : 1128-A PASEO DEL PUEBLO SUR
Second Line : 7653 NDCBU
City : TAOS
State : NM
Zip : 87571
Country : US
Telephone Number : 505-758-3215
Fax Number : 505-751-9280
Authorized Official
Title or Position : PRESIDENT/MANAGER
Name : DR. ROBERT RATZLAFF
Credential : O.D.
Telephone Number : 505-758-3215
Provider Enumeration Date : 11/01/2006
Last Update Date : 08/22/2020

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Directions to “ROBERT RATZLAFF OD LLC ” Practice Location

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