Healthcare Provider Details

I. General information

NPI: 1740306521
Provider Name (Legal Business Name): ALISSA MONTANO IRONS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SLATE AVE NW
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

201 SLATE AVE NW
ALBUQUERQUE NM
87102
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-3463
  • Fax: 505-842-0499
Mailing address:
  • Phone: 505-247-3463
  • Fax: 505-842-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2530
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: