Provider Demographics
NPI:1609889310
Name:CASAUS, DEIDRA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:DEIDRA
Middle Name:MARIE
Last Name:CASAUS
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 1:3566 WHITE HORSE DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3676
Mailing Address - Country:US
Mailing Address - Phone:505-771-3937
Mailing Address - Fax:505-771-1282
Practice Address - Street 1:160 S CAMINO DEL PUEBLO
Practice Address - Street 2:STE E
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6173
Practice Address - Country:US
Practice Address - Phone:505-771-3937
Practice Address - Fax:505-771-1282
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM408152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM01P393OtherBLUE CROSS BLUE SHIELD
NM201001544OtherPRESBYTERIAN HEALTH
NM850429787OtherLOVELACE MOLINA
NMP5028Medicaid
NMNM01P393OtherBLUE CROSS BLUE SHIELD
NMNM0074Medicare PIN