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General NPI Number Information
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NPI Number | 1003095662
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Entity Type | Organization
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Legal Business Name | BOBBY G PAINTER OD
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 3280 N BUTLER AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-2360
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Country | US
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Telephone | 505-325-2015
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Fax | 505-327-9877
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Provider Business Mailing Address
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Address Line | 3280 N BUTLER AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-2360
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Country | US
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Telephone | 505-325-2015
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Fax | 505-327-9877
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | BOBBY G. PAINTER
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Credential | OD
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Telephone | 505-325-2015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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