Healthcare Provider Details

I. General information

NPI: 1841654548
Provider Name (Legal Business Name): NEW MEXICO VISION CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 WYOMING BLVD NE SUITE C1
ALBUQUERQUE NM
87109-3981
US

IV. Provider business mailing address

7007 WYOMING BLVD NE SUITE C1
ALBUQUERQUE NM
87109-3981
US

V. Phone/Fax

Practice location:
  • Phone: 505-828-3937
  • Fax: 505-715-5213
Mailing address:
  • Phone: 505-828-3937
  • Fax: 505-715-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNM611
License Number StateNM

VIII. Authorized Official

Name: DR. TIFFANY GARCIA MARTINEZ
Title or Position: OWNER
Credential: OD
Phone: 505-828-3937