NPIMap

Individual provider Active NPI

David E Magnus, OD

  • Optometrist
  • Albuquerque, NM
National Provider Identifier
1922110600
Registry record updated Oct 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2302 Issued in NM
Practice address
3701 Eubank Blvd NE
Albuquerque, NM 87111
Phone
(505) 298-2020
Fax
(505) 298-2382
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2302 NM Primary

Addresses

Primary practice location

3701 Eubank Blvd NE
Albuquerque, NM 87111

Mailing address

3701 Eubank Blvd NE
Albuquerque, NM 87111
Phone (505) 298-2020

Other identifiers 1

IdentifierTypeStateIssuer
000P9657MedicaidNM

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

LicenseStateTypeSpecialty
2302NMMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Gomez Eyewear, LLC Optometrist Past Accepting new patients
New Mexico Eyecare P.C. Optometrist Past Accepting new patients

Organizations & group practices 2

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349049600000",
    "number": "1922110600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 EUBANK BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87111",
            "telephone_number": "505-298-2020",
            "fax_number": "505-298-2382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 EUBANK BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87111",
            "telephone_number": "505-298-2020",
            "fax_number": "505-298-2382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAGNUS",
        "first_name": "DAVID",
        "middle_name": "E",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NM",
            "license": "2302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000P9657",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.