Provider Demographics
NPI:1841654548
Name:NEW MEXICO VISION CARE
Entity type:Organization
Organization Name:NEW MEXICO VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:GARCIA
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-828-3937
Mailing Address - Street 1:7007 WYOMING BLVD NE
Mailing Address - Street 2:SUITE C1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3981
Mailing Address - Country:US
Mailing Address - Phone:505-828-3937
Mailing Address - Fax:505-715-5213
Practice Address - Street 1:7007 WYOMING BLVD NE
Practice Address - Street 2:SUITE C1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3981
Practice Address - Country:US
Practice Address - Phone:505-828-3937
Practice Address - Fax:505-715-5213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty