Healthcare Provider Details

I. General information

NPI: 1619977196
Provider Name (Legal Business Name): RICHARD C ZOBEL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 WYOMING BLVD NE STE 210
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

5600 WYOMING BLVD NE SUITE 210
ALBUQUERQUE NM
87109-3149
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-6656
  • Fax: 505-884-7951
Mailing address:
  • Phone: 505-884-6656
  • Fax: 505-884-7951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOP2247
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: