Provider Demographics
NPI:1740306521
Name:IRONS, ALISSA MONTANO (OD)
Entity type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:MONTANO
Last Name:IRONS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK1923Medicaid
NMU88260Medicare UPIN
NMK1923Medicaid