| NPI | 1912044348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER KRISTIN TERRY Credentialing COO Rdinator 505-246-2622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 152W00000X Optometrist |
| 156FX1800X Technician/Technologist Optician | |
| 207W00000X Ophthalmology | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2024-12-20 |