1518038330 NPI number — NATIONWIDE OPTOMETRY P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518038330 NPI number — NATIONWIDE OPTOMETRY P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONWIDE OPTOMETRY P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NATIONWIDE VISION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518038330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
955 W SOUTHERN AVE STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85210-4903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-961-1865
Provider Business Mailing Address Fax Number:
480-893-8172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 S MILTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86001-7313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-213-1400
Provider Business Practice Location Address Fax Number:
928-773-1463
Provider Enumeration Date:
11/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CROSS
Authorized Official First Name:
JARROD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
509-201-0051

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)