Provider Demographics
NPI:1871796201
Name:JAY S. FOLKMAN OD PC
Entity type:Organization
Organization Name:JAY S. FOLKMAN OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOLKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ODPC
Authorized Official - Phone:505-881-7440
Mailing Address - Street 1:6821 MONTGOMERY BLVD NE
Mailing Address - Street 2:STE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1444
Mailing Address - Country:US
Mailing Address - Phone:505-881-7440
Mailing Address - Fax:505-837-2117
Practice Address - Street 1:6821 MONTGOMERY BLVD NE
Practice Address - Street 2:STE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1410
Practice Address - Country:US
Practice Address - Phone:505-881-7440
Practice Address - Fax:505-837-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOP2294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPO748Medicaid
NM900521520Medicare PIN
0747940001Medicare NSC
NMT75026Medicare UPIN