Active NPI
Lynn Annette Davis, O.D.
- Optometrist
- Rio Rancho, NM
National Provider Identifier
1417946146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2400
- Practice address
- 1721 Golf Course Rd SE
Rio Rancho, NM 87124-1729 - Phone
- (505) 896-2010
- Fax
- (505) 896-2012
- NPI assigned
- Oct 15, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2400 | NM | Primary |
| Corneal and Contact Management Optometrist | 152WC0802X | 2400 | NM |
Addresses
Primary practice location
1721 Golf Course Rd SE
Rio Rancho, NM 87124-1729
Mailing address
1721 Golf Course Rd SE
Rio Rancho, NM 87124-1729
Phone (505) 896-2010
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P1975 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2400 | NM | MD | Optometrist |
| 400 | NM | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| City of Vision Eyecare, P.C. | Optometrist | Past | Accepting new patients |
| City of Vision Optometry, PC | Optometrist | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optometrist
- Rio Rancho, NM
- NPI 1851865919
-
- Optometrist
- Rio Rancho, NM
- NPI 1811072333
-
- Optometrist
- Rio Rancho, NM
- NPI 1770136269
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691539200000",
"number": "1417946146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1721 GOLF COURSE RD SE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "871241729",
"telephone_number": "505-896-2010",
"fax_number": "505-896-2012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1721 GOLF COURSE RD SE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "871241729",
"telephone_number": "505-896-2010",
"fax_number": "505-896-2012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "LYNN",
"middle_name": "ANNETTE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-10-15",
"last_updated": "2023-08-09",
"certification_date": "2023-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NM",
"license": "2400",
"primary": true
},
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "NM",
"license": "2400",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "P1975",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rio Rancho, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.