Healthcare Provider Details

I. General information

NPI: 1932118734
Provider Name (Legal Business Name): EYE CARE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N CORONADO AVE
ESPANOLA NM
87532-2741
US

IV. Provider business mailing address

105 N CORONADO AVE
ESPANOLA NM
87532-2741
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-7391
  • Fax:
Mailing address:
  • Phone: 505-753-7391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number6164
License Number StateNM

VIII. Authorized Official

Name: DR. GARY PURO
Title or Position: OWNER
Credential: M.D.
Phone: 505-753-7391