Provider Demographics
NPI:1548441777
Name:DOCTORS OPTICAL
Entity type:Organization
Organization Name:DOCTORS OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:AHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-262-3370
Mailing Address - Street 1:5150 JOURNAL CENTER BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5900
Mailing Address - Country:US
Mailing Address - Phone:505-262-3370
Mailing Address - Fax:505-262-3226
Practice Address - Street 1:5150 JOURNAL CENTER BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5900
Practice Address - Country:US
Practice Address - Phone:505-262-3370
Practice Address - Fax:505-262-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM=========OtherTIN