Healthcare Provider Details

I. General information

NPI: 1780853549
Provider Name (Legal Business Name): EYES OF THE SOUTHWEST, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 N TELSHOR BLVD
LAS CRUCES NM
88011-8230
US

IV. Provider business mailing address

2810 N TELSHOR BLVD
LAS CRUCES NM
88011-8230
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-2020
  • Fax:
Mailing address:
  • Phone: 575-523-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number98290
License Number StateNM

VIII. Authorized Official

Name: DR. EDWARD VICTOR HERNANDEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 575-523-2020