Provider Demographics
NPI:1710481726
Name:DESERT MOUNTAIN EYECARE LLC
Entity Type:Organization
Organization Name:DESERT MOUNTAIN EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:SUNNY
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-610-7626
Mailing Address - Street 1:1105 CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:RIO COMMUNITIES
Mailing Address - State:NM
Mailing Address - Zip Code:87002-5941
Mailing Address - Country:US
Mailing Address - Phone:505-610-7625
Mailing Address - Fax:
Practice Address - Street 1:5504 MENAUL BLVD NE STE AANDB
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-610-7626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty