Individual
ROBERT RYAN FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
160 S CAMINO DEL PUEBLO, BERNALILLO, NM 87004-6173
(505) 771-3937
Mailing address
9812 SIERRA MORENA ST NW, ALBUQUERQUE, NM 87114-1419
(713) 572-5128
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT733
NM
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/06/2021
Last updated
08/17/2021
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