Healthcare Provider Details

I. General information

NPI: 1396245098
Provider Name (Legal Business Name): UPTOWN EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 01/10/2021
Certification Date: 01/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 MENAUL BLVD NE STE M5A
ALBUQUERQUE NM
87110-3449
US

IV. Provider business mailing address

816 BOARDMAN DR
GALLUP NM
87301-4711
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-8722
  • Fax:
Mailing address:
  • Phone: 505-339-2015
  • Fax: 505-492-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BRANDI MCGRAW
Title or Position: DOCTOR OF OPTOMETRY, SOLE MEMBER
Credential: OD
Phone: 505-339-2015