Healthcare Provider Details

I. General information

NPI: 1982400925
Provider Name (Legal Business Name): MIGUEL GARCIA SR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MIGUEL GARCIA O.D.

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S GOLD AVE
DEMING NM
88030
US

IV. Provider business mailing address

202 S GOLD AVE
DEMING NM
88030
US

V. Phone/Fax

Practice location:
  • Phone: 575-545-2395
  • Fax:
Mailing address:
  • Phone: 575-545-2395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1745
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: