Healthcare Provider Details

I. General information

NPI: 1265446769
Provider Name (Legal Business Name): KEVIN L MORRIS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MOON ST NE #100
ALBUQUERQUE NM
87112
US

IV. Provider business mailing address

1701 MOON ST NE #100
ALBUQUERQUE NM
87112
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 Number426
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: