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General NPI Number Information
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NPI Number | 1205491206
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Entity Type | Organization
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Legal Business Name | COURTNEY CHAVEZ, OD, PC
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 1420 N RENAISSANCE BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-7008
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Country | US
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Telephone | 505-341-1490
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 N RENAISSANCE BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-7008
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | COURTNEY CHAVEZ
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Credential | OD
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Telephone | 505-301-2561
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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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