Provider Demographics
NPI:1689657694
Name:SILVER CITY OPHTHALMOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:SILVER CITY OPHTHALMOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:APPLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-538-3721
Mailing Address - Street 1:1210 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7229
Mailing Address - Country:US
Mailing Address - Phone:505-538-3721
Mailing Address - Fax:505-538-2207
Practice Address - Street 1:1210 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7229
Practice Address - Country:US
Practice Address - Phone:505-538-3721
Practice Address - Fax:505-538-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM54006Medicaid