Healthcare Provider Details

I. General information

NPI: 1912061086
Provider Name (Legal Business Name): ACCENT ON VISION, SANTA FE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 LUISA ST STE D
SANTA FE NM
87505-7003
US

IV. Provider business mailing address

1409 LUISA ST STE D
SANTA FE NM
87505-7003
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-8989
  • Fax: 505-984-8892
Mailing address:
  • Phone: 505-984-8989
  • Fax: 505-984-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DWIGHT THIBODEAUX
Title or Position: PRESIDENT
Credential: DO
Phone: 505-984-8989