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General NPI Number Information
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NPI Number | 1346362845
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Entity Type | Organization
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Legal Business Name | EYE DEAL VISION P.C.
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 511A HIGHWAY 314 SW
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City | LOS LUNAS
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State | NM
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Zip | 87031-9600
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Country | US
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Telephone | 505-565-3937
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Fax | 505-565-3900
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Provider Business Mailing Address
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Address Line | 511A HIGHWAY 314 SW
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City | LOS LUNAS
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State | NM
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Zip | 87031-9600
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Country | US
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Telephone | 505-565-3937
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Fax | 505-565-3900
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MELLISA R FLOWERS
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Credential |
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Telephone | 505-565-3937
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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 | 1551
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License Number State | NM
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