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General NPI Number Information
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NPI Number | 1326117334
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Entity Type | Organization
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Legal Business Name | EYE AND FACIAL SURGERY OF NM
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6500 JEFFERSON ST NE SUITE 100
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3489
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Country | US
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Telephone | 505-875-0103
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Fax | 505-875-0388
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Provider Business Mailing Address
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Address Line | 6500 JEFFERSON ST NE SUITE 100
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3489
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Country | US
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Telephone | 505-875-0103
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Fax | 505-875-0388
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENNIS M SANDOVAL
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Credential | MD
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Telephone | 505-875-0103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NM
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