Individual provider Active NPI

Ralph W Lightle, O.D.

  • Optometrist
  • Farmington, NM
National Provider Identifier
1215053327
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
324 Issued in NM
Practice address
520 E Main St
Farmington, NM 87401-2712
Phone
(505) 325-2020
Fax
(505) 564-9152
NPI assigned
Mar 21, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 324 NM Primary

Addresses

Primary practice location

520 E Main St
Farmington, NM 87401-2712

Mailing address

520 E Main St
Farmington, NM 87401-2712
Phone (505) 325-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151217002423 NM Practitioner - Optometry 8022319904 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Classic Eyewear, Inc Optometrist CurrentSince Dec 11, 2015 Accepting new patients

Locations

520 E Main St
Farmington, NM 87401
Phone (505) 325-2020

113 W Broadway
Farmington, NM 87401
Phone (505) 326-2020

Organizations & group practices 1

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215053327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 E MAIN ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874012712",
            "telephone_number": "505-325-2020",
            "fax_number": "505-564-9152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 E MAIN ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874012712",
            "telephone_number": "505-325-2020",
            "fax_number": "505-564-9152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIGHTLE",
        "first_name": "RALPH",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NM",
            "license": "324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

Verify at the official NPI Registry.