Provider Demographics
NPI:1770752347
Name:JACK BATTIN
Entity type:Organization
Organization Name:JACK BATTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:575-746-4832
Mailing Address - Street 1:202 WEST TEXAS AVE.
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210
Mailing Address - Country:US
Mailing Address - Phone:575-746-4832
Mailing Address - Fax:575-746-9737
Practice Address - Street 1:202 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-2147
Practice Address - Country:US
Practice Address - Phone:575-746-4832
Practice Address - Fax:575-746-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM220152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0668630001Medicare NSC