MEDICARE: NEW MEXICO PHYSICIANS EYECARE GROUP, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1215407457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MEXICO PHYSICIANS EYECARE GROUP, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 24686
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-4686
Country	:	US
Telephone Number	:	561-275-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	10701 CORRALES RD NW STE 1B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-2159
Country	:	US
Telephone Number	:	505-433-6913
Fax Number	:	505-433-6965

Authorized Official
Title or Position	:	SENIOR REVENUE CYCLE MANAGER
Name	:	ALISHA JACKSON
Credential	:
Telephone Number	:	561-208-1591

Provider Enumeration Date	:	11/30/2018
Last Update Date	:	06/23/2026

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