Healthcare Provider Details

I. General information

NPI: 1407784630
Provider Name (Legal Business Name): ABQ OCULAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 WYOMING BLVD NE STE A2
ALBUQUERQUE NM
87109-6941
US

IV. Provider business mailing address

7708 PICKARD AVE NE
ALBUQUERQUE NM
87110-1562
US

V. Phone/Fax

Practice location:
  • Phone: 505-280-7479
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name: ANDREW MCDONNELL
Title or Position: OWNER/OCULARIST
Credential: BCO, BADO
Phone: 505-280-7479