| NPI | 1063004570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE BENETT Credentialing Manager 505-365-0979 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2021-02-22 |