Healthcare Provider Details

I. General information

NPI: 1780859470
Provider Name (Legal Business Name): ACCENT ON VISION EAST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121 PROSPECT PL NE
ALBUQUERQUE NM
87110-4313
US

IV. Provider business mailing address

7121 PROSPECT PL NE
ALBUQUERQUE NM
87110-4313
US

V. Phone/Fax

Practice location:
  • Phone: 505-239-3274
  • Fax:
Mailing address:
  • Phone: 505-239-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number525
License Number StateNM

VIII. Authorized Official

Name: RENEE FUEMMELER
Title or Position: O.D. OWNER
Credential: OD
Phone: 505-293-3515