Healthcare Provider Details

I. General information

NPI: 1972208379
Provider Name (Legal Business Name): HIGH RESORT EYE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 HIGH RESORT BLVD SE
RIO RANCHO NM
87124-5901
US

IV. Provider business mailing address

8801 HORIZON BLVD NE STE 360
ALBUQUERQUE NM
87113-1563
US

V. Phone/Fax

Practice location:
  • Phone: 505-343-6093
  • Fax:
Mailing address:
  • Phone: 505-246-2622
  • Fax: 505-244-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARTHUR WEINSTEIN
Title or Position: CHAIRMAN OF THE BOARD
Credential: MD
Phone: 505-246-2622