Healthcare Provider Details

I. General information

NPI: 1851032098
Provider Name (Legal Business Name): SALT & LIGHT EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2022
Last Update Date: 04/03/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10409 MONTGOMERY PKWY NE STE 205
ALBUQUERQUE NM
87111-3862
US

IV. Provider business mailing address

10409 MONTGOMERY PKWY NE STE 205
ALBUQUERQUE NM
87111-3862
US

V. Phone/Fax

Practice location:
  • Phone: 505-205-5555
  • Fax:
Mailing address:
  • Phone: 505-205-5555
  • 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. MELYNDA MONTE
Title or Position: OPTOMETRIS/OWNER
Credential: OD
Phone: 505-205-5555