MEDICARE: EYE SURGERY CENTER OF THE DESERT

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	207W00000X	Ophthalmology Physician
2	261QA1903X	Ambulatory Surgical Clinic/Center	CLN2276	CA

General Provider Information

NPI Number	:	1336254770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE SURGERY CENTER OF THE DESERT

Provider Business Mailing Address
First Line	:	72301 COUNTRY CLUB DR
Second Line	:	SUITE 101
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-8007
Country	:	US
Telephone Number	:	760-776-8100
Fax Number	:	760-773-3823

Provider Business Practice Location Address
First Line	:	72301 COUNTRY CLUB DR
Second Line	:	SUITE 101
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-8007
Country	:	US
Telephone Number	:	760-776-8100
Fax Number	:	760-773-3823

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	GEORGE NEAL
Credential	:
Telephone Number	:	844-377-6468

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	02/05/2020

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