Healthcare Provider Details

I. General information

NPI: 1376599936
Provider Name (Legal Business Name): EYEWORKS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 WINTER HAVEN NW SUITE K
ALBUQUERQUE NM
87120
US

IV. Provider business mailing address

6001 WINTER HAVEN NW SUITE K
ALBUQUERQUE NM
87120
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-9577
  • Fax: 505-212-0319
Mailing address:
  • Phone: 505-232-2020
  • Fax: 505-212-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberNM 472
License Number StateNM

VIII. Authorized Official

Name: DR. TINA TASNEEM MAMDANI
Title or Position: OWNER
Credential: O.D.
Phone: 505-232-2020