Individual
DR. DWIGHT THIBODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1409 LUISA ST, SUITE D, SANTA FE, NM 87505-7002
(505) 984-8989
(505) 984-8892
Mailing address
1409 LUISA ST, SUITE D, SANTA FE, NM 87505-7002
(505) 984-8989
(505) 984-8892
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
300
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201009924
PRESBYTERIAN HEALTH PLAN
NM
01
—
850448729
LOVELACE HEALTH PLAN
NM
01
—
850448729T
BLUE CROSS BLUE SHIELD #
NM
01
—
UNITED HEALTH CARE
850448729
NM
Enumeration date
08/18/2006
Last updated
02/28/2008
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