Provider Demographics
NPI:1407044738
Name:ACCENT ON VISION ALBUQUERQUE LLC
Entity type:Organization
Organization Name:ACCENT ON VISION ALBUQUERQUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TACHAU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-898-4884
Mailing Address - Street 1:9131 HIGH ASSETS WAY NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5802
Mailing Address - Country:US
Mailing Address - Phone:505-898-4884
Mailing Address - Fax:505-898-8274
Practice Address - Street 1:9131 HIGH ASSETS WAY NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5802
Practice Address - Country:US
Practice Address - Phone:505-898-4884
Practice Address - Fax:505-898-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOP2325152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM100521056Medicare PIN
NMT75025Medicare UPIN