MEDICARE: OCULAR ONCOLOGY AND MEDICAL RETINA P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0107X	Retina Specialist (Ophthalmology) Physician
2	261QS0132X	Ophthalmologic Surgery Clinic/Center

General Provider Information

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

Provider Business Mailing Address
First Line	:	3100 MONTANA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79903-2503
Country	:	US
Telephone Number	:	915-200-1203
Fax Number	:	915-600-2848

Provider Business Practice Location Address
First Line	:	3100 MONTANA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79903
Country	:	US
Telephone Number	:	915-888-9145
Fax Number	:	534-429-4340

Authorized Official
Title or Position	:	PHYSICIAN / OWNER
Name	:	ERICA RENEE ALVAREZ GONZALEZ
Credential	:
Telephone Number	:	915-200-1203

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	04/06/2026

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