Healthcare Provider Details

I. General information

NPI: 1194709501
Provider Name (Legal Business Name): THE EYE PLACE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 E OLIVE ST
DEMING NM
88030-4747
US

IV. Provider business mailing address

PO BOX 31
DEMING NM
88031-0031
US

V. Phone/Fax

Practice location:
  • Phone: 505-546-4115
  • Fax:
Mailing address:
  • Phone: 505-546-4115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PIERRE KAMGUIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-546-4115