Provider Demographics
NPI:1255720983
Name:DRS MCCLOSKEY AND MENEAKIS
Entity type:Organization
Organization Name:DRS MCCLOSKEY AND MENEAKIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENEAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-753-7355
Mailing Address - Street 1:612 N PASEO DE ONATE
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2963
Mailing Address - Country:US
Mailing Address - Phone:505-753-7355
Mailing Address - Fax:505-753-7533
Practice Address - Street 1:612 N PASEO DE ONATE
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2963
Practice Address - Country:US
Practice Address - Phone:505-753-7355
Practice Address - Fax:505-753-7533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM231152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty