Healthcare Provider Details

I. General information

NPI: 1659483774
Provider Name (Legal Business Name): ABRAN GILBERT OLGUIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 MORRIS ST NE STE A
ALBUQUERQUE NM
87111-3605
US

IV. Provider business mailing address

6309 SUMMERWOOD RD NW
ALBUQUERQUE NM
87120-6107
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-4426
  • Fax:
Mailing address:
  • Phone: 505-205-6656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number575
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: