Provider Demographics
NPI:1851672836
Name:PULIS, ASHLEY J (OD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:J
Last Name:PULIS
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 1:9131 HIGH ASSETS WAY NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5802
Mailing Address - Country:US
Mailing Address - Phone:505-898-4884
Mailing Address - Fax:
Practice Address - Street 1:9131 HIGH ASSETS WAY NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120
Practice Address - Country:US
Practice Address - Phone:505-898-4884
Practice Address - Fax:505-898-8274
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK3543Medicaid
NM25927779Medicaid
NM8HR445Medicare UPIN
NMHSZ189Medicare UPIN
NM25927779Medicaid