Provider Demographics
NPI:1407846371
Name:JAVID, AMIR (OD)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:JAVID
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1563
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:2947 RODEO PARK DR E
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6303
Practice Address - Country:US
Practice Address - Phone:505-983-6613
Practice Address - Fax:505-986-9984
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2008-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG5964Medicaid
NMNM00P892OtherBC BS OF NM
NMNM00P892OtherBC BS OF NM
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