Healthcare Provider Details

I. General information

NPI: 1013051622
Provider Name (Legal Business Name): R TORRES O D P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 N RENAISSANCE BLVD NE SUITE A
ALBUQUERQUE NM
87107-7018
US

IV. Provider business mailing address

6000 TORREON DR NE
ALBUQUERQUE NM
87109-3819
US

V. Phone/Fax

Practice location:
  • Phone: 505-342-1111
  • Fax: 505-342-1121
Mailing address:
  • Phone: 505-342-1111
  • Fax: 505-342-1121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP2177
License Number StateNM

VIII. Authorized Official

Name: DR. RICHARD C TORRES
Title or Position: PRESIDENT
Credential: O.D.
Phone: 505-342-1111