Healthcare Provider Details

I. General information

NPI: 1518922202
Provider Name (Legal Business Name): JULIE ELIZABETH KLEVA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE ELIZABETH KARRER O.D.

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W MAPLE ST SUITE E
FARMINGTON NM
87401-6590
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 505-325-4003
  • Fax: 505-327-6140
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 Number2477
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number577
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: