Healthcare Provider Details

I. General information

NPI: 1568550002
Provider Name (Legal Business Name): NEW MEXICO EYE CLINIC LL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 JACKIE RD SE STE 850
RIO RANCHO NM
87124-6606
US

IV. Provider business mailing address

1316 JACKIE RD SE STE 850
RIO RANCHO NM
87124-6606
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-0880
  • Fax: 505-891-5415
Mailing address:
  • Phone: 505-891-0880
  • Fax: 505-891-5415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number258
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number76-254
License Number StateNM

VIII. Authorized Official

Name: DR. DONALD E RODGERS
Title or Position: M.D. -OWNER
Credential:
Phone: 505-891-0880