Individual
DANIEL JOHN DIETERICHS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3701 EUBANK BLVD NE, ALBUQUERQUE, NM 87111-3536
(505) 298-2020
Mailing address
1606 JACK NICKLAUS DR, BELEN, NM 87002-5925
(505) 450-5343
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
390
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E8983
—
NM
01
—
201014237
PRESBYTERIAN NEW MEXICO
NM
01
—
410049648
RAILROAD MEDICARE INDIVID
NM
01
—
4991500001
DMERC
NM
01
—
DA6066
RAILROAD MEDICARE GROUP
NM
01
—
NM00P502
BLUE CROSS AND BLUE SHIEL
NM
Enumeration date
08/10/2006
Last updated
02/26/2020
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