Organization
BLUE WHALE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIS S MUNCEY OD (OWNER)
(505) 899-8993
Entity
Organization
Contact information
Practice address
9935 COORS BYP NW, STE B, ALBUQUERQUE, NM 87114-6195
(505) 899-8993
(505) 898-8994
Mailing address
9935 COORS BYP NW STE B, ALBUQUERQUE, NM 87114-6195
(505) 899-8993
(505) 898-8994
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2427
NM
152W00000X
Optometrist
640
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
93424817
—
NM
Enumeration date
11/26/2014
Last updated
12/07/2017
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