Provider Demographics
NPI:1528147865
Name:REALEYES INC
Entity type:Organization
Organization Name:REALEYES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RATZLAFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:575-758-3215
Mailing Address - Street 1:1353 PASEO DEL PUEBLO SUR
Mailing Address - Street 2:SUITE C
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5801
Mailing Address - Country:US
Mailing Address - Phone:575-758-3215
Mailing Address - Fax:575-751-9280
Practice Address - Street 1:1353 PASEO DEL PUEBLO SUR
Practice Address - Street 2:SUITE C
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5801
Practice Address - Country:US
Practice Address - Phone:575-758-3215
Practice Address - Fax:575-751-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty