Healthcare Provider Details

I. General information

NPI: 1255373676
Provider Name (Legal Business Name): EYE SURGERY CENTERS OF NEW MEXICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2947 RODEO PARK DR E
SANTA FE NM
87505-6303
US

IV. Provider business mailing address

PO BOX 90550
ALBUQUERQUE NM
87199-0550
US

V. Phone/Fax

Practice location:
  • Phone: 505-474-9880
  • Fax: 505-474-9881
Mailing address:
  • Phone: 505-768-1333
  • Fax: 505-244-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number3076
License Number StateNM

VIII. Authorized Official

Name: MRS. JANICE E. YOUNG
Title or Position: CFO
Credential:
Phone: 505-246-2622