Provider Demographics
NPI:1336334119
Name:DR ALISSA M IRONS LLC
Entity Type:Organization
Organization Name:DR ALISSA M IRONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:IRONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-247-3463
Mailing Address - Street 1:201 SLATE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102
Mailing Address - Country:US
Mailing Address - Phone:505-247-3463
Mailing Address - Fax:505-842-0499
Practice Address - Street 1:201 SLATE AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-247-3463
Practice Address - Fax:505-842-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM2530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK1923Medicaid
NM900521230Medicare PIN