Provider Demographics
NPI:1114058005
Name:ALBUQUERQUE ASSOCIATES OF OPTOMETRY
Entity Type:Organization
Organization Name:ALBUQUERQUE ASSOCIATES OF OPTOMETRY
Other - Org Name:SANDIA VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHINISCI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-298-2020
Mailing Address - Street 1:3701 EUBANK BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3536
Mailing Address - Country:US
Mailing Address - Phone:505-298-2020
Mailing Address - Fax:505-298-2382
Practice Address - Street 1:3701 EUBANK BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3536
Practice Address - Country:US
Practice Address - Phone:505-298-2020
Practice Address - Fax:505-298-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP7438Medicaid
NMP7438Medicaid
NM0743270001Medicare NSC