Provider Demographics
NPI:1922277011
Name:NEW MEXICO EYECARE P.C.
Entity Type:Organization
Organization Name:NEW MEXICO EYECARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:D.C.
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-828-0828
Mailing Address - Street 1:10701 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE L
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3816
Mailing Address - Country:US
Mailing Address - Phone:505-828-0828
Mailing Address - Fax:505-828-0848
Practice Address - Street 1:10701 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE L
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3816
Practice Address - Country:US
Practice Address - Phone:505-828-0828
Practice Address - Fax:505-828-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM275152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM900522317Medicare PIN