Provider Demographics
NPI:1326117334
Name:EYE AND FACIAL SURGERY OF NM
Entity Type:Organization
Organization Name:EYE AND FACIAL SURGERY OF NM
Other - Org Name:EYE AND FACIAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-875-0103
Mailing Address - Street 1:6500 JEFFERSON ST NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3489
Mailing Address - Country:US
Mailing Address - Phone:505-875-0103
Mailing Address - Fax:505-875-0388
Practice Address - Street 1:6500 JEFFERSON ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3489
Practice Address - Country:US
Practice Address - Phone:505-875-0103
Practice Address - Fax:505-875-0388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty