Individual
MARIO J. ANDREATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4025 JACKIE RD SE, RIO RANCHO, NM 87124-6610
(505) 892-8411
(505) 891-5497
Mailing address
4025 JACKIE RD SE, RIO RANCHO, NM 87124-6610
(505) 892-8411
(505) 891-5497
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OP2438
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006007
AHCCCS
AZ
05
—
152W0000X
—
NM
01
—
NM0438
EYE MED ID
—
01
—
NMOP2438
LICENSE #
NM
Enumeration date
07/13/2005
Last updated
04/23/2008
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