MEDICARE: MR. MIGUEL ANGEL AVALOS A.B.O.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	156FX1800X	Optician	07981	NM

General Provider Information

NPI Number	:	1639386881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIGUEL ANGEL AVALOS A.B.O.C.

Provider Business Mailing Address
First Line	:	3961 E LOHMAN AVE
Second Line	:	SUITE 11
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8269
Country	:	US
Telephone Number	:	575-522-6868
Fax Number	:	575-522-6869

Provider Business Practice Location Address
First Line	:	3961 E LOHMAN AVE
Second Line	:	SUITE 11
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8269
Country	:	US
Telephone Number	:	575-522-6868
Fax Number	:	575-522-6869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	11/05/2008

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