Healthcare Provider Details

I. General information

NPI: 1164825287
Provider Name (Legal Business Name): ALVAREZ REIGSTAD OPTOMETRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 EUBANK BLVD SE SUITE A
ALBUQUERQUE NM
87123-3338
US

IV. Provider business mailing address

2109 GOLD AVE SE
ALBUQUERQUE NM
87106-4005
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-2555
  • Fax: 505-323-0888
Mailing address:
  • Phone: 951-312-9596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number585
License Number StateNM

VIII. Authorized Official

Name: DR. LUISA RAHELL ALVAREZ
Title or Position: PRESIDENT/OPTOMETRIST
Credential: OD
Phone: 951-312-9596