Individual
DANIEL JOHN DIETERICHS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
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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