Healthcare Provider Details

I. General information

NPI: 1528275344
Provider Name (Legal Business Name): CHRISTY TORRES OPTICAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 METRO AVE
GALLUP NM
87301-5383
US

IV. Provider business mailing address

825 METRO AVE
GALLUP NM
87301-5383
US

V. Phone/Fax

Practice location:
  • Phone: 505-726-1993
  • Fax:
Mailing address:
  • Phone: 505-726-1993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: