Provider Demographics
NPI:1164509956
Name:RATZLAFF, ROBERT D (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:RATZLAFF
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1353 PASEO DEL PUEBLO SUR
Mailing Address - Street 2:SUITE C
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5801
Mailing Address - Country:US
Mailing Address - Phone:575-758-3215
Mailing Address - Fax:575-751-9280
Practice Address - Street 1:1353 PASEO DEL PUEBLO SUR
Practice Address - Street 2:SUITE C
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5801
Practice Address - Country:US
Practice Address - Phone:575-758-3215
Practice Address - Fax:575-751-9280
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMU66175Medicare UPIN