Provider Demographics
NPI:1104868520
Name:EYE ASSOCIATES OF NEW MEXICO LTD
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF NEW MEXICO LTD
Other - Org Name:EYE ASSOCIATES OF NEW MEXICO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ROLANDE
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-828-4923
Mailing Address - Street 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:806 DR MARTIN LUTHER KING JR AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3657
Practice Address - Country:US
Practice Address - Phone:505-842-6575
Practice Address - Fax:505-213-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK5006Medicaid
CO94-000619Medicaid
NMCH4370OtherRAILROAD MEDICARE
NMCN6728OtherRAILROAD MEDICARE
AZ310132Medicaid
NM47951Medicaid
TX1198269-02Medicaid
NMCH4370OtherRAILROAD MEDICARE
CO94-000619Medicaid