Healthcare Provider Details

I. General information

NPI: 1881644433
Provider Name (Legal Business Name): GILA EYECARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 W SPRING ST
SILVER CITY NM
88061-4847
US

IV. Provider business mailing address

604 W SPRING ST
SILVER CITY NM
88061-4847
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-4464
  • Fax: 575-388-2014
Mailing address:
  • Phone: 575-388-4464
  • Fax: 575-388-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS M. MITTICA JR.
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 575-388-4464