Provider Demographics
NPI:1356660252
Name:FILLMORE EYE CLINIC INC, ASC
Entity Type:Organization
Organization Name:FILLMORE EYE CLINIC INC, ASC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:FILLMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:575-434-1200
Mailing Address - Street 1:1124 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6414
Mailing Address - Country:US
Mailing Address - Phone:575-434-1200
Mailing Address - Fax:575-437-3947
Practice Address - Street 1:1124 10TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6414
Practice Address - Country:US
Practice Address - Phone:575-434-1200
Practice Address - Fax:575-437-3947
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FILLMORE EYE CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6134261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical