Dean H Hattan, OD
Individual provider Active NPI Optometrist · Acoma, NM
NPI 1174592877 · NPPES record last updated Aug 1, 2016
Key facts
- NPI
- 1174592877
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2106 (AZ)
- Practice address
- 80 B Veterans Blvd
I-40, Exit 102
Acoma, NM 87034 - Phone
- (505) 552-5300
- Fax
- (505) 552-5811
- NPI assigned
- Mar 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001231 | WA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dean Hattan OD | Optometrist | Past |
Accepting new patients |
| Paris Investments LLC | Optometrist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 001231 | WA | |
| Optometrist | 152W00000X | 2106 | AZ | Yes |
Addresses
Primary practice location
80 B Veterans Blvd
I-40, Exit 102
Acoma, NM 87034
Mailing address
PO Box 130
San Fidel, NM 87049-0130
Phone (505) 552-5300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H3450 | Medicaid | NM |
Other providers in Acoma, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.