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General NPI Number Information
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NPI Number | 1316136443
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Entity Type | Organization
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Legal Business Name | L VICTOR SANDOVAL, P.C.
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 700 S TELSHOR BLVD STE #1534
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City | LAS CRUCES
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State | NM
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Zip | 88011-8608
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Country | US
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Telephone | 575-522-8334
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Fax | 575-522-1065
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Provider Business Mailing Address
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Address Line | 700 S TELSHOR BLVD STE #1534
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City | LAS CRUCES
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State | NM
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Zip | 88011
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Country | US
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Telephone | 575-522-8334
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Fax | 575-522-1065
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. L VICTOR SANDOVAL
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Credential | O.D.
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Telephone | 575-522-8334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 2260
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License Number State | NM
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