Provider Demographics
NPI:1871625947
Name:PEREA-MAES, JUDY ANN (OD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:ANN
Last Name:PEREA-MAES
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:6321 RIVERSIDE PLAZA LN NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2642
Mailing Address - Country:US
Mailing Address - Phone:505-897-3937
Mailing Address - Fax:505-899-1224
Practice Address - Street 1:6321 RIVERSIDE PLAZA LN NW
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2642
Practice Address - Country:US
Practice Address - Phone:505-897-3937
Practice Address - Fax:505-899-1224
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM2298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM0298OtherEYEMED VISION PLAN
NM30-NM00003OtherAVESIS VISION PLAN