Healthcare Provider Details

I. General information

NPI: 1457498321
Provider Name (Legal Business Name): EYE ASSOCIATES OF NEW MEXICO, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W 21ST ST SUITE R-1
CLOVIS NM
88101-4087
US

IV. Provider business mailing address

8801 HORIZON BLVD NE SUITE 360
ALBUQUERQUE NM
87113-1533
US

V. Phone/Fax

Practice location:
  • Phone: 505-763-3445
  • Fax: 505-762-2690
Mailing address:
  • Phone: 505-246-2622
  • Fax: 505-213-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CAROLE JEAN WRIGHT
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential: CAO
Phone: 505-768-1335