Provider Demographics
NPI:1235293499
Name:BAHRAMI, MATTHEW (OD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BAHRAMI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 10TH ST
Mailing Address - Street 2:MBAHRAMI19@GMAIL.COM
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310
Mailing Address - Country:US
Mailing Address - Phone:575-434-1200
Mailing Address - Fax:575-437-3947
Practice Address - Street 1:801 BUSH AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210
Practice Address - Country:US
Practice Address - Phone:575-736-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOPT-2025-0013152W00000X
TNOD1816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3943151Medicaid
TN3943152Medicare ID - Type UnspecifiedOD PIN
TN3943151Medicaid