Healthcare Provider Details

I. General information

NPI: 1083188585
Provider Name (Legal Business Name): HEARING AND VISION STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 MENAUL BLVD NE STE F
ALBUQUERQUE NM
87112-2200
US

IV. Provider business mailing address

8400 MENAUL BLVD NE STE F
ALBUQUERQUE NM
87112-2200
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-7777
  • Fax:
Mailing address:
  • Phone: 505-299-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROMY PIERCE
Title or Position: OWNER
Credential:
Phone: 505-299-7777