Healthcare Provider Details

I. General information

NPI: 1770433633
Provider Name (Legal Business Name): PABLO ALFONSO CHAVEZ ABOC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 MADERO AVE
LAS CRUCES NM
88005-2206
US

IV. Provider business mailing address

1132 MADERO AVE
LAS CRUCES NM
88005-2206
US

V. Phone/Fax

Practice location:
  • Phone: 575-621-2539
  • Fax:
Mailing address:
  • Phone: 575-621-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number261573
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: