Provider Demographics
NPI:1962995787
Name:SOUTHWEST RETINA RESEARCH CENTER, LLC
Entity type:Organization
Organization Name:SOUTHWEST RETINA RESEARCH CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BATCHELOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-828-2200
Mailing Address - Street 1:270 E 8TH AVE STE N-101
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5708
Mailing Address - Country:US
Mailing Address - Phone:970-828-2200
Mailing Address - Fax:970-828-2201
Practice Address - Street 1:270 E 8TH AVE STE N-101
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5708
Practice Address - Country:US
Practice Address - Phone:970-828-2200
Practice Address - Fax:970-828-2201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST RETINA CONSULTANTS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO56814207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty