Healthcare Provider Details

I. General information

NPI: 1164685558
Provider Name (Legal Business Name): KEVIN L MORRIS OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MOON ST NE SUITE 100
ALBUQUERQUE NM
87112-3900
US

IV. Provider business mailing address

8621 LAS CAMAS RD NE
ALBUQUERQUE NM
87111-2342
US

V. Phone/Fax

Practice location:
  • Phone: 505-341-1010
  • Fax:
Mailing address:
  • Phone: 505-341-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2426
License Number StateNM

VIII. Authorized Official

Name: DR. KEVIN LANE MORRIS
Title or Position: PRESIDENT
Credential: OD
Phone: 505-341-1010