Dallin Bassett OD LLC
Organization Active NPI Optometrist · Aztec, NM
NPI 1548092430 · NPPES record last updated Aug 19, 2024
Key facts
- NPI
- 1548092430
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- DALLIN BASSETT OD LLC
- Practice address
- 121 N Main Ave
Aztec, NM 87410-1923 - Phone
- (505) 333-7278
- NPI assigned
- Aug 19, 2024
- Organization subpart
- No
Authorized official
- Name
- Dr. Dallin Bassett, OD
- Title
- Owner/Optometrist
- Phone
- (832) 613-1096
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241114000069 | NM | Part B Supplier - Clinic/Group Practice | 4082148903 |
Receives reassigned benefits from 1 practitioner Practice locations: Aztec, NM |
National Provider Directory
Locations
121 N Main Ave
Aztec, NM 87410
Phone (505) 333-7278
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
121 N Main Ave
Aztec, NM 87410-1923
Mailing address
4916 Kingsway Dr
Farmington, NM 87402-4861
Phone (832) 613-1096
Other providers in Aztec, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.