Provider Demographics
NPI:1821127499
Name:SOUTHWEST EYE CLINIC P.C.
Entity Type:Organization
Organization Name:SOUTHWEST EYE CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:VILLALOBOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:575-521-1158
Mailing Address - Street 1:2030 S SOLANO DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5402
Mailing Address - Country:US
Mailing Address - Phone:505-521-1158
Mailing Address - Fax:505-521-1007
Practice Address - Street 1:2030 S SOLANO DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5402
Practice Address - Country:US
Practice Address - Phone:505-521-1158
Practice Address - Fax:505-521-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-11-26
Deactivation Date:2008-07-18
Deactivation Code:
Reactivation Date:2008-11-26
Provider Licenses
StateLicense IDTaxonomies
NM83137207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMBO4736Medicare UPIN
NM452948250Medicare PIN