Provider Demographics
NPI:1740620327
Name:CONTACT LENS GALLERY, INC.
Entity type:Organization
Organization Name:CONTACT LENS GALLERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PEREA-MAES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-897-3937
Mailing Address - Street 1:6321 RIVERSIDE PLAZA LN NW STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2641
Mailing Address - Country:US
Mailing Address - Phone:505-897-3937
Mailing Address - Fax:505-899-1224
Practice Address - Street 1:6321 RIVERSIDE PLAZA LN NW STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2641
Practice Address - Country:US
Practice Address - Phone:505-897-3937
Practice Address - Fax:505-899-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMFA0005635261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty