Healthcare Provider Details

I. General information

NPI: 1598572307
Provider Name (Legal Business Name): BASIN EYE SURGERY, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4222 WENDOVER AVE STE 800
ODESSA TX
79762-5915
US

IV. Provider business mailing address

PO BOX 12256
ODESSA TX
79768-2256
US

V. Phone/Fax

Practice location:
  • Phone: 432-280-4008
  • Fax: 432-280-4028
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURA FARBER
Title or Position: OPHTHALMOLOGIST / PRACTICE OWNER
Credential: MD
Phone: 432-280-4008