Provider Demographics
NPI:1578574828
Name:FAMILY EYE CARE/CHILDREN'S EYE CENTER OF NEW MEXICO, P.C.
Entity Type:Organization
Organization Name:FAMILY EYE CARE/CHILDREN'S EYE CENTER OF NEW MEXICO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-900-3467
Mailing Address - Street 1:303 MULBERRY NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4739
Mailing Address - Country:US
Mailing Address - Phone:505-243-9739
Mailing Address - Fax:505-842-0650
Practice Address - Street 1:303 MULBERRY ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4739
Practice Address - Country:US
Practice Address - Phone:505-243-9739
Practice Address - Fax:505-842-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0328750001Medicare NSC