Provider Demographics
NPI:1942443825
Name:PRECISION OPTICAL LABORATORY, L.L.C.
Entity Type:Organization
Organization Name:PRECISION OPTICAL LABORATORY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GARCIA-PEREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-897-2468
Mailing Address - Street 1:5115 COORS BLVD., N.W.
Mailing Address - Street 2:SUITE E
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1926
Mailing Address - Country:US
Mailing Address - Phone:505-897-2468
Mailing Address - Fax:505-897-8207
Practice Address - Street 1:5115 COORS BLVD., N.W.
Practice Address - Street 2:SUITE E
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1926
Practice Address - Country:US
Practice Address - Phone:505-897-2468
Practice Address - Fax:505-897-8207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM02-422969-00-001332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0779OtherVISION SERVICE PLAN
627OtherVISION BENEFITS OF AMERICA