Healthcare Provider Details

I. General information

NPI: 1578574828
Provider Name (Legal Business Name): FAMILY EYE CARE/CHILDREN'S EYE CENTER OF NEW MEXICO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 MULBERRY ST NE
ALBUQUERQUE NM
87106-4739
US

IV. Provider business mailing address

303 MULBERRY NE SUITE D
ALBUQUERQUE NM
87106-4739
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-9739
  • Fax: 505-842-0650
Mailing address:
  • Phone: 505-243-9739
  • Fax: 505-842-0650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE CASAUS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 505-900-3467