Healthcare Provider Details

I. General information

NPI: 1215019237
Provider Name (Legal Business Name): CEDAR CREST VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 NORTH HIGHWAY 14 SUITE 3
CEDAR CREST NM
87008
US

IV. Provider business mailing address

PO BOX 1640
CEDAR CREST NM
87008-1640
US

V. Phone/Fax

Practice location:
  • Phone: 505-286-0300
  • Fax: 505-281-4765
Mailing address:
  • Phone: 505-286-0300
  • Fax: 505-281-4765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT H. QUICK
Title or Position: MEMBER OF LLC
Credential: O.D.
Phone: 505-286-0300