Provider Demographics
NPI:1982733325
Name:NEW MEXICO LIONS CRANE READING FOUNDATION
Entity Type:Organization
Organization Name:NEW MEXICO LIONS CRANE READING FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECOND VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-649-5878
Mailing Address - Street 1:3315 HIGHRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-8508
Mailing Address - Country:US
Mailing Address - Phone:505-649-5878
Mailing Address - Fax:
Practice Address - Street 1:3315 HIGHRIDGE ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-8508
Practice Address - Country:US
Practice Address - Phone:505-649-5878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM40473520Medicaid