Healthcare Provider Details

I. General information

NPI: 1033800792
Provider Name (Legal Business Name): OCULAR ONCOLOGY AND MEDICAL RETINA P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MONTANA AVE
EL PASO TX
79903
US

IV. Provider business mailing address

3100 MONTANA AVE
EL PASO TX
79903
US

V. Phone/Fax

Practice location:
  • Phone: 915-888-9145
  • Fax: 534-429-4340
Mailing address:
  • Phone: 915-888-9145
  • Fax: 534-429-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERICA ALVAREZ GONZALEZ
Title or Position: OWNER / PHYSICIAN
Credential: MD
Phone: 915-253-3625