1114964939 NPI number — SEDONA EYE CARE PC

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 1114964939 NPI number — SEDONA EYE CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEDONA EYE CARE PC
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:
WRIGHT CHRISTENSEN DRS
Provider Other Organization Name Type Code:
4
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:
1114964939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 SOLDIERS PASS ROAD
Provider Second Line Business Mailing Address:
STE A1
Provider Business Mailing Address City Name:
SEDONA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86336-4781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-282-4126
Provider Business Mailing Address Fax Number:
928-282-5762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 SOLDIERS PASS ROAD
Provider Second Line Business Practice Location Address:
STE A1
Provider Business Practice Location Address City Name:
SEDONA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86336-4781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-282-4126
Provider Business Practice Location Address Fax Number:
928-282-5762
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
SERGE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
928-282-4126

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  262 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AZ0171820 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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