Healthcare Provider Details

I. General information

NPI: 1912182932
Provider Name (Legal Business Name): ALBUQUERQUE ASSOCIATES OF OPTOMETRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HERMOSA DR SE
ALBUQUERQUE NM
87108-2610
US

IV. Provider business mailing address

112 HERMOSA DR SE
ALBUQUERQUE NM
87108-2610
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-3443
  • Fax: 505-265-7006
Mailing address:
  • Phone: 505-265-3443
  • Fax: 505-265-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2326
License Number StateNM

VIII. Authorized Official

Name: KAZUKO K PURO
Title or Position: CO-OWNER
Credential: O.D.
Phone: 505-265-3443