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NPI Code Detail

MEDICARE: AMIR JAVID O.D.

MEDICARE: AMIR JAVID O.D.
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
1152W00000XOptometrist532NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2NM00P892OTHERNMBC BS OF NM

General Provider Information

NPI Number : 1407846371
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMIR JAVID O.D.
Provider Business Mailing Address
First Line : 8801 HORIZON BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87113-1563
Country : US
Telephone Number : 505-828-4923
Fax Number : 505-213-0103
Provider Business Practice Location Address
First Line : 2947 RODEO PARK DR E
Second Line :
City : SANTA FE
State : NM
Zip : 87505-6303
Country : US
Telephone Number : 505-983-6613
Fax Number : 505-986-9984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 04/20/2008

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