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General NPI Number Information
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NPI Number | 1942443825
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Entity Type | Organization
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Legal Business Name | PRECISION OPTICAL LABORATORY, L.L.C.
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 04/08/2009
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Provider Practice Location Address
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Address Line | 5115 COORS BLVD., N.W. SUITE E
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1926
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Country | US
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Telephone | 505-897-2468
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Fax | 505-897-8207
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Provider Business Mailing Address
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Address Line | 5115 COORS BLVD., N.W. SUITE E
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1926
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Country | US
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Telephone | 505-897-2468
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Fax | 505-897-8207
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Authorized Official
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Title or Position | PARTNER
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Name | MRS. CELESTE ANNE GARCIA-PEREA
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Credential |
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Telephone | 505-897-2468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 02-422969-00-001
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License Number State | NM
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