Provider Demographics
NPI:1104295906
Name:FILLMORE EYE CLINIC INCORPORATED
Entity type:Organization
Organization Name:FILLMORE EYE CLINIC INCORPORATED
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
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:575-443-0200
Mailing Address - Fax:
Practice Address - Street 1:1120 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:575-443-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FILLMORE EYE CLINIC INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-22
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM2009-0470207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty