Healthcare Provider Details

I. General information

NPI: 1629916804
Provider Name (Legal Business Name): ANDREW MCDONNELL BCO, BADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7708 PICKARD AVE NE
ALBUQUERQUE NM
87110-1562
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: 505-280-7479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: