NPI 1154463099 · live from the CMS NPI Registry
Brooks Randall Alldredge, O.D.
Optometrist in Albuquerque, NM. National Provider Identifier 1154463099, active.
NPI record
| NPI | 1154463099 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 8220 San Pedro Dr Ne, Suite 220, Albuquerque, NM 87113 |
| Practice phone | 505-797-4466 |
| Mailing address | Po Box 1506, Chehalis, WA 98532 |
| Enumerated | February 13, 2007 |
| Last updated | November 12, 2020 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist | 152W00000X | ODP-100001 (ID) |
| Optometrist | 152W00000X | ATI2539 (OR) |
| Optometrist | 152W00000X | OD00001864 (WA) |
| Optometrist | 152W00000X | OPT-OPT-LIC-2803 (MT) |
| Optometrist primary | 152W00000X | OPT589 (NM) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.