Provider Demographics
NPI:1295054351
Name:EYE CARE OF NEW MEXICO, INC.
Entity type:Organization
Organization Name:EYE CARE OF NEW MEXICO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDE
Authorized Official - Middle Name:T
Authorized Official - Last Name:WAGGONER
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MPH, MS
Authorized Official - Phone:505-323-2555
Mailing Address - Street 1:500 EUBANK BLVD SE
Mailing Address - Street 2:STE. A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-3338
Mailing Address - Country:US
Mailing Address - Phone:505-323-2555
Mailing Address - Fax:505-323-0888
Practice Address - Street 1:500 EUBANK BLVD SE
Practice Address - Street 2:STE. A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-3338
Practice Address - Country:US
Practice Address - Phone:505-323-2555
Practice Address - Fax:505-323-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM547152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty