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General NPI Number Information
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NPI Number | 1679011191
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Entity Type | Organization
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Legal Business Name | OPTOMETRICS PC
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 612 N PASEO DE ONATE
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City | ESPANOLA
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State | NM
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Zip | 87532-2963
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Country | US
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Telephone | 505-753-7355
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Fax | 505-753-7533
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Provider Business Mailing Address
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Address Line | 612 N PASEO DE ONATE
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City | ESPANOLA
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State | NM
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Zip | 87532-2963
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Country | US
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Telephone | 505-753-7355
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Fax | 505-753-7533
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL H MENEAKIS
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Credential | OD
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Telephone | 505-753-7355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | NM307
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License Number State | NM
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