Organization
CASEY OPTICAL TOO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLY ADAMS BRODERICK (MANAGING MEMBER)
(505) 379-2158
Entity
Organization
Contact information
Practice address
9000 MENAUL BLVD NE, ALBUQUERQUE, NM 87112-2231
(505) 219-3113
(505) 792-6608
Mailing address
9000 MENAUL BLVD NE, ALBUQUERQUE, NM 87112-2231
(505) 219-3113
(505) 792-6608
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09703381
—
NM
Enumeration date
03/10/2016
Last updated
08/30/2022
Update your record
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