Provider Demographics
NPI:1760717425
Name:MAYES, JAMES DANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DANIEL
Last Name:MAYES
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 1:723 N TURNER ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-8234
Mailing Address - Country:US
Mailing Address - Phone:575-393-2020
Mailing Address - Fax:575-397-4319
Practice Address - Street 1:723 N TURNER ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-8234
Practice Address - Country:US
Practice Address - Phone:575-393-2020
Practice Address - Fax:575-397-4319
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM606152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM43909361Medicaid
NMNM303390Medicare PIN