Healthcare Provider Details

I. General information

NPI: 1144427295
Provider Name (Legal Business Name): PUEBLO OF ZUNI OPTICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203B ST. HWY. 53 1203B ST. HWY. 53
ZUNI NM
87327-0339
US

IV. Provider business mailing address

PO BOX 339 1203B ST. HWY. 53
ZUNI NM
87327-0339
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-7198
  • Fax:
Mailing address:
  • Phone: 505-782-7198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: MR. LANNY LATONE
Title or Position: PROGRAM MANAGER
Credential:
Phone: 505-782-7198