Thomas S. Raffaele, O.D.
Individual provider Active NPI Optometrist · Mescalero, NM
NPI 1437268687 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1437268687
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2063 (WA)
- Practice address
- 101 Sage Avenue
Mescalero, NM 88340-0210 - Phone
- (505) 464-3835
- Fax
- (505) 464-4512
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2063 | WA | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2063 | WA | Yes |
Addresses
Primary practice location
101 Sage Avenue
Mescalero, NM 88340-0210
Mailing address
PO Box 210
Mescalero, NM 88340-0210
Phone (505) 464-3835
Other providers in Mescalero, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.