Provider Demographics
NPI:1790790160
Name:BRATCHER, JASON ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALLEN
Last Name:BRATCHER
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 1:611N HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5436
Mailing Address - Country:US
Mailing Address - Phone:575-538-2994
Mailing Address - Fax:575-538-2996
Practice Address - Street 1:611N HUDSON ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5436
Practice Address - Country:US
Practice Address - Phone:575-538-2994
Practice Address - Fax:575-538-2996
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM568152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2590482Medicaid
NM78653037Medicaid
NM342701803Medicare PIN