Provider Demographics
NPI:1093954612
Name:FOLKMAN VISE AND ASSOCIATES EYE CLINIC
Entity Type:Organization
Organization Name:FOLKMAN VISE AND ASSOCIATES EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:VISE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-822-8387
Mailing Address - Street 1:6821 MONTGOMERY BLVD NE
Mailing Address - Street 2:STE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1444
Mailing Address - Country:US
Mailing Address - Phone:505-881-7440
Mailing Address - Fax:505-837-2117
Practice Address - Street 1:6208 MONTGOMERY BLVD NE
Practice Address - Street 2:STE E
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1400
Practice Address - Country:US
Practice Address - Phone:505-822-8387
Practice Address - Fax:505-883-9512
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAY S FOLKMAN OD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-05
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOP2411152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0747940001Medicare NSC
NM900521520Medicare PIN