Provider Demographics
NPI:1972805349
Name:PHILIP TREU OD PC
Entity Type:Organization
Organization Name:PHILIP TREU OD PC
Other - Org Name:SANTA FE EYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:TREU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-983-4709
Mailing Address - Street 1:2008 SAINT MICHAELS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7682
Mailing Address - Country:US
Mailing Address - Phone:505-983-4709
Mailing Address - Fax:505-954-0707
Practice Address - Street 1:2008 SAINT MICHAELS DR
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7682
Practice Address - Country:US
Practice Address - Phone:505-983-4709
Practice Address - Fax:505-954-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOP2622152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMOP2622OtherTHERAPEUTIC OPTOMETRY LICENSE - NEW MEXICO
NMOP2219OtherTHERAPEUTIC OPTOMETRY LICENSE - NM
NMU62857Medicare UPIN