Provider Demographics
NPI:1346663721
Name:SOUTHWEST RETINA CONSULTANTS PC
Entity Type:Organization
Organization Name:SOUTHWEST RETINA CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:N
Authorized Official - Last Name:BATCHELOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-828-2200
Mailing Address - Street 1:270 E 8TH AVE STE N-101
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5743
Mailing Address - Country:US
Mailing Address - Phone:970-828-2200
Mailing Address - Fax:970-828-2201
Practice Address - Street 1:270 E 8TH AVE STE N-101
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5743
Practice Address - Country:US
Practice Address - Phone:970-828-2200
Practice Address - Fax:970-828-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0050343207W00000X, 207WX0107X
CO0056814207W00000X, 207WX0107X
NMMD2012-0618207W00000X, 207WX0107X
NMMD2016-0574207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA1933Medicare PIN