Provider Demographics
NPI:1467425769
Name:SCHMELTZER, LEN J (OD)
Entity Type:Individual
Prefix:
First Name:LEN
Middle Name:J
Last Name:SCHMELTZER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E VALVERDE RD
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-8223
Mailing Address - Country:US
Mailing Address - Phone:505-332-2020
Mailing Address - Fax:505-332-8343
Practice Address - Street 1:5343 WYOMING BLVD NE
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3199
Practice Address - Country:US
Practice Address - Phone:505-332-2020
Practice Address - Fax:505-332-8343
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM367152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000P1266Medicaid
NM000P1266Medicaid
NM349403804Medicare ID - Type UnspecifiedMEDICARE NUMBER