Provider Demographics
NPI:1285935379
Name:GIRON FAMILY VISION GALLERY, LLC
Entity type:Organization
Organization Name:GIRON FAMILY VISION GALLERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:GIRON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-890-3937
Mailing Address - Street 1:4820 MESA BONITA CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3365
Mailing Address - Country:US
Mailing Address - Phone:505-890-3937
Mailing Address - Fax:
Practice Address - Street 1:10600 COORS BYP NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-3930
Practice Address - Country:US
Practice Address - Phone:505-890-3937
Practice Address - Fax:505-890-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty