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General NPI Number Information
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NPI Number | 1639247604
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Entity Type | Individual
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Provider Name | RONALD STEPHEN VIGIL O.D., F.A.A.O.
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Gender | Male
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 7009 MONTGOMERY BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-1598
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Country | US
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Telephone | 505-883-2550
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Fax | 505-881-8931
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Provider Business Mailing Address
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Address Line | 4235 ALTURA VISTA LN NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5064
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Country | US
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Telephone | 505-266-6082
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Fax | 505-881-8931
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 491
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License Number State | NM
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