Provider Demographics
NPI:1649384710
Name:TACHAU, PAUL A (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:TACHAU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1409 LUISA ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7002
Mailing Address - Country:US
Mailing Address - Phone:505-984-8989
Mailing Address - Fax:505-984-8892
Practice Address - Street 1:1409 LUISA ST
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7002
Practice Address - Country:US
Practice Address - Phone:505-984-8989
Practice Address - Fax:505-984-8892
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM325152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM01P398OtherBLUE CROSS BLUE SHIELD
NM201009817OtherPRESBYTERIAN
NM9921367OtherCIGNA
NMNM01P505OtherBLUE CROSS BLUE SHIELD
NM201009816OtherPRESBYTERIAN
NM349236501Medicare PIN
NM9921367OtherCIGNA
NM201009816OtherPRESBYTERIAN