NPI 1164536165 · live from the CMS NPI Registry
Mamie Cassandra Chan, OD
Optometrist in Albuquerque, NM. National Provider Identifier 1164536165, active.
NPI record
| NPI | 1164536165 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 5341 Wyoming Blvd Ne Ste D, Albuquerque, NM 87109 |
| Practice phone | 505-821-8333 |
| Mailing address | 5341 Wyoming Blvd Ne, Ste D, Albuquerque, NM 87109 |
| Enumerated | August 18, 2006 |
| Last updated | May 25, 2016 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist primary | 152W00000X | 512 (NM) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.