Healthcare Provider Details

I. General information

NPI: 1700941168
Provider Name (Legal Business Name): ACOMA OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 5TH ST
SANTA FE NM
87505-3427
US

IV. Provider business mailing address

1521 5TH ST
SANTA FE NM
87505-3427
US

V. Phone/Fax

Practice location:
  • Phone: 150-598-8532
  • Fax: 150-599-5133
Mailing address:
  • Phone: 150-598-8532
  • Fax: 150-599-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN BODDY
Title or Position: PRESIDENT OWNER
Credential: OPTICIAN
Phone: 15059885321