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General NPI Number Information
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NPI Number | 1316100225
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Entity Type | Organization
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Legal Business Name | RUIDOSO NATIONAL OPTICAL CENTER
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 1800 HIGHWAY 70 WEST
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City | RUIDOSO DOWNS
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State | NM
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Zip | 88346
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Country | US
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Telephone | 505-255-9410
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Fax | 505-255-9875
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Provider Business Mailing Address
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Address Line | 301 SAN MATEO BLVD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-2919
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Country | US
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Telephone | 505-378-7148
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Fax | 505-378-1117
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. BILL G MCDONALD
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Credential | O.D.
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Telephone | 505-378-7148
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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 | 251
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License Number State | NM
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