Provider Demographics
NPI:1841221231
Name:SOUTHWEST EYECARE SPECIALISTS P C
Entity Type:Organization
Organization Name:SOUTHWEST EYECARE SPECIALISTS P C
Other - Org Name:SW EYECARE SPECIALISTS P C
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TEAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-346-0500
Mailing Address - Street 1:7110 WYOMING BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4867
Mailing Address - Country:US
Mailing Address - Phone:505-346-0500
Mailing Address - Fax:505-346-0164
Practice Address - Street 1:7110 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4867
Practice Address - Country:US
Practice Address - Phone:505-346-0500
Practice Address - Fax:505-346-0164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM300521053Medicare PIN
NM300521053Medicare PIN