Provider Demographics
NPI:1912182932
Name:ALBUQUERQUE ASSOCIATES OF OPTOMETRY
Entity Type:Organization
Organization Name:ALBUQUERQUE ASSOCIATES OF OPTOMETRY
Other - Org Name:SANDIA VISIOM CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAZUKO
Authorized Official - Middle Name:K
Authorized Official - Last Name:PURO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-265-3443
Mailing Address - Street 1:112 HERMOSA DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2610
Mailing Address - Country:US
Mailing Address - Phone:505-265-3443
Mailing Address - Fax:505-265-7006
Practice Address - Street 1:112 HERMOSA DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2610
Practice Address - Country:US
Practice Address - Phone:505-265-3443
Practice Address - Fax:505-265-7006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBUQUERQUE ASSOCIATES OF OPTOMETRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP7438Medicaid