Provider Demographics
NPI:1700995941
Name:LOOKS, PA
Entity Type:Organization
Organization Name:LOOKS, PA
Other - Org Name:OPTOMETRIC VISION CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-526-3314
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-0819
Mailing Address - Country:US
Mailing Address - Phone:575-526-3314
Mailing Address - Fax:575-526-1061
Practice Address - Street 1:330 E BOUTZ RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3255
Practice Address - Country:US
Practice Address - Phone:575-526-3314
Practice Address - Fax:575-526-1061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMDB5629OtherRAILROAD MEDICARE
NML8384Medicaid
400521102Medicare PIN