Provider Demographics
NPI:1417107004
Name:FOUR POINTS EYE CENTER, PC
Entity Type:Organization
Organization Name:FOUR POINTS EYE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-438-6111
Mailing Address - Street 1:2705 NAKOMIS DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2037
Mailing Address - Country:US
Mailing Address - Phone:512-736-1504
Mailing Address - Fax:
Practice Address - Street 1:4250 CERRILLOS RD STE 1272
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-0954
Practice Address - Country:US
Practice Address - Phone:505-438-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM620152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty