Healthcare Provider Details

I. General information

NPI: 1841681269
Provider Name (Legal Business Name): NEW MEXICO LASER EYE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 EAST LLANO ESTACADO BLVD. SUITE A
CLOVIS NM
88101
US

IV. Provider business mailing address

PO BOX 50720
AMARILLO TX
79159-0720
US

V. Phone/Fax

Practice location:
  • Phone: 806-353-0125
  • Fax: 806-355-0834
Mailing address:
  • Phone: 806-467-0459
  • Fax: 806-355-1284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROL T CARPENTER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 806-467-0459