Individual
LAURA COUNTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
122 PLAZA ST, SOCORRO, NM 87801-4566
(575) 835-3937
Mailing address
CAMPUS STATION, BOX 2021, SOCORRO, NM 87801
(575) 418-8456
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
692
NM
Other
Enumeration date
08/20/2014
Last updated
12/08/2017
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