Healthcare Provider Details

I. General information

NPI: 1811072333
Provider Name (Legal Business Name): CITY OF VISION EYECARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 JACKIE RD SE
RIO RANCHO NM
87124-6610
US

IV. Provider business mailing address

4025 JACKIE RD SE
RIO RANCHO NM
87124-6610
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-8411
  • Fax: 505-891-5497
Mailing address:
  • Phone: 505-892-8411
  • Fax: 505-891-5497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP2264
License Number StateNM

VIII. Authorized Official

Name: DR. DEAN S. REYNOLDS
Title or Position: CO-OWNER
Credential: O.D.
Phone: 505-892-8411