Healthcare Provider Details

I. General information

NPI: 1316136443
Provider Name (Legal Business Name): L VICTOR SANDOVAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S TELSHOR BLVD STE #1534
LAS CRUCES NM
88011-8608
US

IV. Provider business mailing address

700 S TELSHOR BLVD STE #1534
LAS CRUCES NM
88011
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-8334
  • Fax: 575-522-1065
Mailing address:
  • Phone: 575-522-8334
  • Fax: 575-522-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2260
License Number StateNM

VIII. Authorized Official

Name: DR. L VICTOR SANDOVAL
Title or Position: OWNER/PRESIDENT
Credential: O.D.
Phone: 575-522-8334