Healthcare Provider Details

I. General information

NPI: 1578767828
Provider Name (Legal Business Name): EYE CARE FOR YOU, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5341 WYOMING BLVD NE STE D
ALBUQUERQUE NM
87109-3164
US

IV. Provider business mailing address

5341 WYOMING BLVD NE STE D
ALBUQUERQUE NM
87109-3164
US

V. Phone/Fax

Practice location:
  • Phone: 505-821-8333
  • Fax:
Mailing address:
  • Phone: 505-821-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. MAMIE C CHAN
Title or Position: OWNER
Credential: OD
Phone: 505-821-8333