| NPI | 1518147602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA ANN DIETERICHS Practice Manager 505-864-8992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NM NM0P2390) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2007-11-06 |