Healthcare Provider Details

I. General information

NPI: 1497319693
Provider Name (Legal Business Name): CLEAR CHOICE VISION CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 MENAUL BLVE NE SUITE M5A
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

6020 SILVER LEAF TRL NE
ALBUQUERQUE NM
87111-8095
US

V. Phone/Fax

Practice location:
  • Phone: 806-282-2146
  • Fax:
Mailing address:
  • Phone: 806-282-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RANDAL D JENTZEN
Title or Position: OPTOMETRIST/OWNER
Credential: O.D.
Phone: 806-282-2146