Healthcare Provider Details

I. General information

NPI: 1336254770
Provider Name (Legal Business Name): EYE SURGERY CENTER OF THE DESERT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72301 COUNTRY CLUB DR SUITE 101
RANCHO MIRAGE CA
92270-8007
US

IV. Provider business mailing address

72301 COUNTRY CLUB DR SUITE 101
RANCHO MIRAGE CA
92270-8007
US

V. Phone/Fax

Practice location:
  • Phone: 760-776-8100
  • Fax: 760-773-3823
Mailing address:
  • Phone: 760-776-8100
  • Fax: 760-773-3823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberCLN2276
License Number StateCA

VIII. Authorized Official

Name: GEORGE NEAL
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 844-377-6468