# DAVID VISE OD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346685658
- **Authorized official:** DR. DAVID RICHARD VISE O.D. (OPTOMETRIST)
- **Authorized official phone:** (505) 473-5100

## Contact information

- **Practice address:** 3530 ZAFARANO DR, SUITE C1, SANTA FE, NM 87507-2617
- **Practice address phone:** (505) 473-5100
- **Practice address fax:** (505) 473-5104
- **Mailing address:** 3530 ZAFARANO DR, SUITE C1, SANTA FE, NM 87507-2617
- **Mailing address phone:** (505) 473-5100
- **Mailing address fax:** (505) 473-5104

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 411 | NM | Yes |

## Other

- **Enumeration date:** 05/01/2013
- **Last updated:** 08/13/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | J9416 | — | NM |