Provider Demographics
NPI:1891737474
Name:FOLKMAN, JAY S (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:S
Last Name:FOLKMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6821 MONTGOMERY NE
Mailing Address - Street 2:STE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1444
Mailing Address - Country:US
Mailing Address - Phone:505-881-7440
Mailing Address - Fax:505-837-2117
Practice Address - Street 1:6821 MONTGOMERY NE
Practice Address - Street 2:STE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1444
Practice Address - Country:US
Practice Address - Phone:505-881-7440
Practice Address - Fax:505-837-2117
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOP2294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPO748Medicaid
T75026Medicare UPIN
NM0747940001Medicare NSC
NM900521520Medicare PIN