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General NPI Number Information
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NPI Number | 1407044738
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Entity Type | Organization
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Legal Business Name | ACCENT ON VISION ALBUQUERQUE LLC
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 09/21/2012
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Provider Practice Location Address
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Address Line | 9131 HIGH ASSETS WAY NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-5802
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Country | US
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Telephone | 505-898-4884
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Fax | 505-898-8274
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Provider Business Mailing Address
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Address Line | 9131 HIGH ASSETS WAY NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-5802
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Country | US
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Telephone | 505-898-4884
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Fax | 505-898-8274
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. PAUL TACHAU
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Credential | O.D.
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Telephone | 505-898-4884
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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 | OP2325
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License Number State | NM
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