Provider Demographics
NPI:1285723650
Name:ALBUQUERQUE EYE PROSTHETICS INC
Entity type:Organization
Organization Name:ALBUQUERQUE EYE PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:505-884-2927
Mailing Address - Street 1:4117 MONTGOMERY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1102
Mailing Address - Country:US
Mailing Address - Phone:505-884-2927
Mailing Address - Fax:505-884-2672
Practice Address - Street 1:4117 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1102
Practice Address - Country:US
Practice Address - Phone:505-884-2927
Practice Address - Fax:505-884-2672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT2326Medicaid
NMT2326Medicaid