Provider Demographics
NPI:1851726533
Name:BOTWIN, VANLIN CHAN (OD)
Entity type:Individual
Prefix:
First Name:VANLIN
Middle Name:CHAN
Last Name:BOTWIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2136
Mailing Address - Country:US
Mailing Address - Phone:505-982-2020
Mailing Address - Fax:
Practice Address - Street 1:125 W WATER ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2136
Practice Address - Country:US
Practice Address - Phone:505-982-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM658152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP01284318OtherRAILROAD MEDICARE
NM87955822Medicaid
NM87955822Medicaid