Healthcare Provider Details

I. General information

NPI: 1427490994
Provider Name (Legal Business Name): RICHARD BRANDON RUNYON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2947 RODEO PARK DR E
SANTA FE NM
87505-6303
US

IV. Provider business mailing address

8801 HORIZON BLVD NE STE 360
ALBUQUERQUE NM
87113-1563
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-6613
  • Fax: 505-986-9984
Mailing address:
  • Phone: 505-246-2622
  • Fax: 505-715-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-2025-0018
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2792
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1963DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: