Healthcare Provider Details

I. General information

NPI: 1922566769
Provider Name (Legal Business Name): V.A.C, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6321 RIVERSIDE PLAZA LN NW STE B
ALBUQUERQUE NM
87120-2641
US

IV. Provider business mailing address

6321 RIVERSIDE PLAZA LN NW STE B
ALBUQUERQUE NM
87120-2641
US

V. Phone/Fax

Practice location:
  • Phone: 505-897-3937
  • Fax:
Mailing address:
  • Phone: 505-897-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: VANESSA A CHAVEZ
Title or Position: O.D./OWNER
Credential:
Phone: 505-899-3937