Healthcare Provider Details

I. General information

NPI: 1326613555
Provider Name (Legal Business Name): SOPHIA CLAIRE RIES OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

07 CHOOSHGAI DRIVE
TOHATCHI NM
87325
US

IV. Provider business mailing address

PO BOX 1337
GALLUP NM
87305-1337
US

V. Phone/Fax

Practice location:
  • Phone: 505-733-8100
  • Fax:
Mailing address:
  • Phone: 505-722-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0003675
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: