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General NPI Number Information
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NPI Number | 1104868520
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Entity Type | Organization
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Legal Business Name | EYE ASSOCIATES OF NEW MEXICO LTD
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 806 DR MARTIN LUTHER KING JR AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-3657
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Country | US
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Telephone | 505-842-6575
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Fax | 505-213-0103
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Provider Business Mailing Address
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Address Line | 8801 HORIZON BLVD NE SUITE 360
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1533
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Country | US
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Telephone | 505-828-4923
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Fax | 505-213-0103
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Authorized Official
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Title or Position | CREDENTIALING ADMINISTRATOR
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Name | MICHELLE ROLANDE BUTCHER
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Credential |
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Telephone | 505-828-4923
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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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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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