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General NPI Number Information
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NPI Number | 1376670992
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Entity Type | Organization
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Legal Business Name | ANASAZI EYECARE DBA VISIONWEST
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 800 TRINITY DR STE J
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City | LOS ALAMOS
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State | NM
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Zip | 87544-4105
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Country | US
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Telephone | 505-662-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 800 TRINITY DR STE J
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City | LOS ALAMOS
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State | NM
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Zip | 87544-4105
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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 | DOCTOR
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Name | WENDE W WAGGONER
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Credential |
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Telephone | 505-662-7000
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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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