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General NPI Number Information
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NPI Number | 1164685558
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Entity Type | Organization
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Legal Business Name | KEVIN L MORRIS OD PC
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 06/24/2009
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Provider Practice Location Address
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Address Line | 1701 MOON ST NE SUITE 100
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-3900
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Country | US
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Telephone | 505-341-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 8621 LAS CAMAS RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2342
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Country | US
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Telephone | 505-341-1010
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN LANE MORRIS
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Credential | OD
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Telephone | 505-341-1010
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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 | 2426
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License Number State | NM
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