Healthcare Provider Details

I. General information

NPI: 1497808554
Provider Name (Legal Business Name): CONTACT LENS ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4253 MONTGOMERY BLVD NE SUITE 110
ALBUQUERQUE NM
87109-1106
US

IV. Provider business mailing address

4253 MONTGOMERY BLVD NE SUITE 110
ALBUQUERQUE NM
87109-1106
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-2550
  • Fax:
Mailing address:
  • Phone: 505-883-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number StateNM

VIII. Authorized Official

Name: DR. RONALD S VIGIL
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 505-883-2550