MEDICARE: DARYL W. BIGELOW 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
1	152W00000X	Optometrist	416	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00151438	OTHER	NM	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	NM00PA10	OTHER	NM	BC BS OF NM

General Provider Information

NPI Number	:	1548268428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL W. BIGELOW O.D.

Provider Business Mailing Address
First Line	:	8801 HORIZON BLVD NE
Second Line	:	SUITE 360
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1533
Country	:	US
Telephone Number	:	505-246-2622
Fax Number	:	505-213-0103

Provider Business Practice Location Address
First Line	:	1740 GRANDE BLVD SE
Second Line	:	SUITE B
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-1799
Country	:	US
Telephone Number	:	505-892-3434
Fax Number	:	505-891-2402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	04/25/2008

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