Individual
DR. JASON C. KOSCHMEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5200 EUBANK BLVD NE, SUITE A-4, ALBUQUERQUE, NM 87111-1759
(505) 298-4419
(505) 298-0878
Mailing address
8801 HORIZON BLVD NE, SUITE 360, ALBUQUERQUE, NM 87113-1533
(505) 828-4923
(505) 213-0103
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
660
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78880386
—
NM
Enumeration date
09/16/2013
Last updated
12/05/2014
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