Healthcare Provider Details

I. General information

NPI: 1184364374
Provider Name (Legal Business Name): 505 EYECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6821 MONTGOMERY BLVD NE STE C
ALBUQUERQUE NM
87109-1444
US

IV. Provider business mailing address

7604 RIO GUADALUPE PL NE
ALBUQUERQUE NM
87122-2790
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-7440
  • Fax:
Mailing address:
  • Phone: 505-331-7423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: CARA MORRIS
Title or Position: OPTOMETRIST
Credential: OD
Phone: 505-331-7423