Provider Demographics
NPI:1669467163
Name:STROSNIDER, JEFFREY C (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:STROSNIDER
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 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:1740 GRANDE BLVD SE
Practice Address - Street 2:SUITE B
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1799
Practice Address - Country:US
Practice Address - Phone:505-892-3434
Practice Address - Fax:505-891-2402
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM404152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM410047679OtherRRB MEDICARE RAILROAD
AZ647654Medicaid
NMZ8057Medicaid
NMNM00P945OtherBC BS OF NM
AZ647654Medicaid
NMZ8057Medicaid