Provider Demographics
NPI:1740295120
Name:OPHTHALMIC ANESTHESIA SERVICES
Entity type:Organization
Organization Name:OPHTHALMIC ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-243-7754
Mailing Address - Street 1:PO BOX 30585
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87190-0585
Mailing Address - Country:US
Mailing Address - Phone:505-243-7754
Mailing Address - Fax:505-243-4804
Practice Address - Street 1:11005 SPAIN RD NE STE 17
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1871
Practice Address - Country:US
Practice Address - Phone:505-243-7729
Practice Address - Fax:505-243-4804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM89174836Medicaid
NM89174836Medicaid