Provider Demographics
NPI:1164685558
Name:KEVIN L MORRIS OD PC
Entity Type:Organization
Organization Name:KEVIN L MORRIS OD PC
Other - Org Name:FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-341-1010
Mailing Address - Street 1:8621 LAS CAMAS RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2342
Mailing Address - Country:US
Mailing Address - Phone:505-341-1010
Mailing Address - Fax:
Practice Address - Street 1:1701 MOON ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3900
Practice Address - Country:US
Practice Address - Phone:505-341-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEVIN L MORRIS OD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-07
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM80939848Medicaid
DO7105OtherRAILROAD MEDICARE
10008813OtherLOVELACE HEALTH PLAN
10008813OtherLOVELACE HEALTH PLAN