Provider Demographics
NPI:1841211927
Name:BATTIN, JOHN L (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:BATTIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:L
Other - Last Name:BATTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:202 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-2147
Mailing Address - Country:US
Mailing Address - Phone:505-746-4832
Mailing Address - Fax:505-746-9737
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:505-746-4832
Practice Address - Fax:505-746-9737
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM 0220152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPO854Medicaid
NMT74945Medicare UPIN
NMPO854Medicaid
NM2590684Medicare ID - Type Unspecified