Provider Demographics
NPI:1144427295
Name:PUEBLO OF ZUNI OPTICAL SERVICES
Entity Type:Organization
Organization Name:PUEBLO OF ZUNI OPTICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LATONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-782-7198
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:1203B ST. HWY. 53
Mailing Address - City:ZUNI
Mailing Address - State:NM
Mailing Address - Zip Code:87327-0339
Mailing Address - Country:US
Mailing Address - Phone:505-782-7198
Mailing Address - Fax:
Practice Address - Street 1:1203B ST. HWY. 53
Practice Address - Street 2:1203B ST. HWY. 53
Practice Address - City:ZUNI
Practice Address - State:NM
Practice Address - Zip Code:87327-0339
Practice Address - Country:US
Practice Address - Phone:505-782-7198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty