Healthcare Provider Details

I. General information

NPI: 1093954604
Provider Name (Legal Business Name): ULTRAVISION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 MENAUL BLVD NE
ALBUQUERQUE NM
87107-1714
US

IV. Provider business mailing address

2127 MENAUL BLVD NE
ALBUQUERQUE NM
87107-1714
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-2020
  • Fax: 505-880-0029
Mailing address:
  • Phone: 505-884-2020
  • Fax: 505-880-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ARLENE T.H. SOKOLA
Title or Position: OWNER
Credential: OD
Phone: 505-884-2020