MEDICARE: SKYVIEW EYECARE INC

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	529	NM

General Provider Information

NPI Number	:	1700075843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYVIEW EYECARE INC

Provider Business Mailing Address
First Line	:	3450 E MAIN ST
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87402-5327
Country	:	US
Telephone Number	:	505-325-7070
Fax Number	:	505-325-5812

Provider Business Practice Location Address
First Line	:	3450 E MAIN ST
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87402-5327
Country	:	US
Telephone Number	:	505-325-7070
Fax Number	:	505-325-5812

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GORDON D RUSSELL
Credential	:	O.D.
Telephone Number	:	505-325-7070

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	08/01/2013

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Directions to “SKYVIEW EYECARE INC ” Practice Location

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