Healthcare Provider Details

I. General information

NPI: 1568520682
Provider Name (Legal Business Name): RIO EYECARE & CONTACT LENSES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 CRESTVIEW DR SE
RIO RANCHO NM
87124-5942
US

IV. Provider business mailing address

4100 CRESTVIEW DR SE
RIO RANCHO NM
87124-5942
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-2020
  • Fax: 505-891-2010
Mailing address:
  • Phone: 505-891-2020
  • Fax: 505-891-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CRAIG F CLATANOFF
Title or Position: PRESIDENT
Credential: OD
Phone: 505-891-2020