Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | NM536 | NM |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | NM536 | NM |
N | 152WP0200X | Pediatric Optomitrist | NM536 | NM |
N | 152WV0400X | Optomitrist - Vision Therapist | NM536 | NM |
NPI | 1003999301 |
---|---|
Provider Name | Dr. Farid Elie Khoury |
First Address | Gallup, NM 87301-5644 |
Second Address | Gallup, NM 87301-5898 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25676 | SPECTERA (01) | NM |
44840 | DAVIS VISION (01) | NM |
52032019 | (05) | NM |