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General NPI Number Information
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NPI Number | 1003999301
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Entity Type | Individual
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Provider Name | FARID ELIE KHOURY O.D
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1500 S 2ND ST STE 5
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City | GALLUP
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State | NM
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Zip | 87301-5898
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Country | US
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Telephone | 505-979-0894
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Fax | 505-726-2871
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Provider Business Mailing Address
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Address Line | 1912 MOUNTAIN VIEW DR
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City | GALLUP
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State | NM
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Zip | 87301-5644
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Country | US
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Telephone | 505-979-0894
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Fax | 505-726-2871
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | NM536
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | NM536
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | NM536
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | NM536
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License Number State | NM
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