Provider Demographics
NPI:1710087861
Name:TIBBETTS, CATHY (OD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:
Last Name:TIBBETTS
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 1:6750 FOOTHILLS DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-0928
Mailing Address - Country:US
Mailing Address - Phone:505-215-4675
Mailing Address - Fax:
Practice Address - Street 1:6750 FOOTHILLS DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-0928
Practice Address - Country:US
Practice Address - Phone:505-215-4675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist