Healthcare Provider Details

I. General information

NPI: 1922343888
Provider Name (Legal Business Name): BERNITSKY VISION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 HOLLY AVE NE
ALBUQUERQUE NM
87113-2474
US

IV. Provider business mailing address

6401 HOLLY AVE NE
ALBUQUERQUE NM
87113-2474
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-0800
  • Fax: 505-323-6221
Mailing address:
  • Phone: 505-323-0800
  • Fax: 505-323-6221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number88-122
License Number StateNM

VIII. Authorized Official

Name: JACQUI DONNELL
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 505-323-0800