Provider Demographics
NPI:1134248479
Name:JAMES H DUDEN
Entity type:Organization
Organization Name:JAMES H DUDEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:DUDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-762-5266
Mailing Address - Street 1:2200 NORTH MAIN ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101
Mailing Address - Country:US
Mailing Address - Phone:505-762-5266
Mailing Address - Fax:505-762-5266
Practice Address - Street 1:2200 NORTH MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101
Practice Address - Country:US
Practice Address - Phone:505-762-5266
Practice Address - Fax:505-762-5266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
39726OtherDAVIS VISION
NM0094OtherEYE MED VISION CARE
NMP8824Medicaid
NMP8824Medicaid