Provider Demographics
NPI:1982922670
Name:GOMEZ EYEWEAR, LLC
Entity Type:Organization
Organization Name:GOMEZ EYEWEAR, LLC
Other - Org Name:NEW MEXICO EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-620-0185
Mailing Address - Street 1:10701 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE L
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3816
Mailing Address - Country:US
Mailing Address - Phone:505-828-0828
Mailing Address - Fax:505-828-0848
Practice Address - Street 1:10701 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE L
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3816
Practice Address - Country:US
Practice Address - Phone:505-828-0828
Practice Address - Fax:505-828-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty