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General NPI Number Information
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NPI Number | 1992189757
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Entity Type | Organization
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Legal Business Name | TJK VISION LLC
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Dates
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Enumeration Date | 07/11/2015
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Last Update Date | 07/11/2015
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Provider Practice Location Address
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Address Line | 201 W FOX ST
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City | CARLSBAD
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State | NM
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Zip | 88220-5736
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Country | US
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Telephone | 575-885-3937
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Fax | 575-885-1178
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Provider Business Mailing Address
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Address Line | 201 W FOX ST
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City | CARLSBAD
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State | NM
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Zip | 88220-5736
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Country | US
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Telephone | 575-885-3937
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Fax | 575-885-1178
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. THOMAS KUNZ
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Credential | OD
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Telephone | 208-251-8669
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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 | NM 629
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License Number State | NM
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