MEDICARE: EYES OF NM FAMILY OPTOMETRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WL0500X	Low Vision Rehabilitation Optometrist	611	NM
2	152WP0200X	Pediatric Optometrist	611	NM
3	152WV0400X	Vision Therapy Optometrist	611	NM
4	152W00000X	Optometrist	611	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396042792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYES OF NM FAMILY OPTOMETRY LLC

Provider Business Mailing Address
First Line	:	7007 WYOMING BLVD NE
Second Line	:	SUITE C-1
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3987
Country	:	US
Telephone Number	:	505-828-3937
Fax Number	:	505-715-5213

Provider Business Practice Location Address
First Line	:	502 EL PUEBLO RD NW
Second Line	:
City	:	LOS RANCHOS
State	:	NM
Zip	:	87114-1105
Country	:	US
Telephone Number	:	505-385-0826
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. TIFFANY GARCIA MARTINEZ
Credential	:	O.D.
Telephone Number	:	505-385-0826

Provider Enumeration Date	:	02/21/2011
Last Update Date	:	05/11/2020

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Directions to “EYES OF NM FAMILY OPTOMETRY LLC ” Practice Location

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