Provider Demographics
NPI:1588637714
Name:MAMDANI, TASNEEM TINA (OD)
Entity Type:Individual
Prefix:DR
First Name:TASNEEM
Middle Name:TINA
Last Name:MAMDANI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 WINTER HAVEN NW
Mailing Address - Street 2:SUITE K
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1745
Mailing Address - Country:US
Mailing Address - Phone:505-232-2020
Mailing Address - Fax:505-212-0319
Practice Address - Street 1:6001 WINTER HAVEN NW
Practice Address - Street 2:SUITE K
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1745
Practice Address - Country:US
Practice Address - Phone:505-232-2020
Practice Address - Fax:505-212-0319
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NML8443Medicaid
NM344617001Medicare PIN
NML8443Medicaid