Provider Demographics
NPI:1124754395
Name:EYE-SITE ROSWELL LLC
Entity type:Organization
Organization Name:EYE-SITE ROSWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-397-3611
Mailing Address - Street 1:1811 N DAL PASO ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-3042
Mailing Address - Country:US
Mailing Address - Phone:575-397-3611
Mailing Address - Fax:575-393-1544
Practice Address - Street 1:1100 N MAIN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4909
Practice Address - Country:US
Practice Address - Phone:575-397-3611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty