=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700995941
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOOKS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 11/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 E BOUTZ RD
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88005-3255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-526-3314
-----------------------------------------------------
Fax | 575-526-1061
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 819
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88004-0819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-526-3314
-----------------------------------------------------
Fax | 575-526-1061
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLER
-----------------------------------------------------
Name | MONICA CARMONA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 575-526-3314
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------