Mamie Cassandra Chan, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

512 Issued in NM

Practice address

5341 Wyoming Blvd NE Ste D
Albuquerque, NM 87109-3164

Phone

(505) 821-8333

Fax

(505) 821-8335

NPI assigned

Aug 18, 2006

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eye Care for You, P.C.

  • Optometrist
  • Albuquerque, NM
  • NPI 1578767828
  NPD (past) Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 25, 2016.

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464134400000",
    "number": "1164536165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5341 WYOMING BLVD NE",
            "address_2": "STE D",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871093164",
            "telephone_number": "505-717-2005",
            "fax_number": "505-312-7551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5341 WYOMING BLVD NE STE D",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871093164",
            "telephone_number": "505-821-8333",
            "fax_number": "505-821-8335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "MAMIE",
        "middle_name": "CASSANDRA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-18",
        "last_updated": "2016-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NM",
            "license": "512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A4896",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Champion, MD
• Ashley Champlin
• Roberta Champouillon, NP
• Jennifer Chan, MD
• Karen Chan, PT
• Patrick Chan, M.D.
• Ryan Chan
• Terence C Chan, MD
• Adriana Chancay
• Krista Chance

• All providers in Albuquerque, NM
• Optometrist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.