Organization
GALLUP EYE GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDI MCGRAW OD (PRESIDENT/OD)
(505) 339-2015
Entity
Organization
Contact information
Practice address
816 BOARDMAN DR, GALLUP, NM 87301-4711
(505) 339-2015
(505) 492-0904
Mailing address
816 BOARDMAN DR, GALLUP, NM 87301-4711
(505) 339-2015
(505) 492-0904
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16438311
—
NM
05
—
525331
—
AZ
Enumeration date
07/26/2018
Last updated
01/10/2021
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