Organization
ACCENT ON VISION, SANTA FE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DWIGHT THIBODEAUX DO (PRESIDENT)
(505) 984-8989
Entity
Organization
Contact information
Practice address
1409 LUISA ST STE D, SANTA FE, NM 87505-7003
(505) 984-8989
(505) 984-8892
Mailing address
1409 LUISA ST STE D, SANTA FE, NM 87505-7003
(505) 984-8989
(505) 984-8892
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BLUE CROSS BLUE SHIE
NM00P121
NM
05
—
NM MEDICAID
—
NM
Enumeration date
12/21/2006
Last updated
07/16/2012
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