Provider Demographics
NPI:1891298030
Name:MICHAEL D. HERRERA, O.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL D. HERRERA, O.D., P.C.
Other - Org Name:DR. MICHAEL D. HERRERA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENEANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-428-0809
Mailing Address - Street 1:4 RUSTY SPUR PL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-1350
Mailing Address - Country:US
Mailing Address - Phone:505-429-0809
Mailing Address - Fax:505-438-8100
Practice Address - Street 1:3811 CERRILLOS RD STE 103
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4112
Practice Address - Country:US
Practice Address - Phone:505-989-9600
Practice Address - Fax:505-438-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP6026Medicaid