MEDICARE: DR R L JARRELL PA

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
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1457411886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR R L JARRELL PA

Provider Business Mailing Address
First Line	:	3901 GEORGIA ST NE
Second Line	:	SUITE A2
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1359
Country	:	US
Telephone Number	:	505-883-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 GEORGIA ST NE
Second Line	:	SUITE A2
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1359
Country	:	US
Telephone Number	:	505-883-4200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT L JARRELL
Credential	:	OD
Telephone Number	:	505-883-4200

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	03/23/2012

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