Provider Demographics
NPI:1265446769
Name:MORRIS, KEVIN L (OD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:L
Last Name:MORRIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 MOON ST NE
Mailing Address - Street 2:#100
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112
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:#100
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112
Practice Address - Country:US
Practice Address - Phone:505-341-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM11325828Medicaid
P00700786OtherRAILROAD MEDICARE
P00700786OtherRAILROAD MEDICARE
NM11325828Medicaid
NM00085Medicare PIN