Provider Demographics
NPI:1003095662
Name:BOBBY G PAINTER OD
Entity Type:Organization
Organization Name:BOBBY G PAINTER OD
Other - Org Name:HIGH DESERT EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-325-2015
Mailing Address - Street 1:3280 N BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2360
Mailing Address - Country:US
Mailing Address - Phone:505-325-2015
Mailing Address - Fax:505-327-9877
Practice Address - Street 1:3280 N BUTLER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2360
Practice Address - Country:US
Practice Address - Phone:505-325-2015
Practice Address - Fax:505-327-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty