1629312822 NPI number — OPHTHALMIC ANESTHESIA SERVICES, INC.

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 1629312822 NPI number — OPHTHALMIC ANESTHESIA SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPHTHALMIC ANESTHESIA SERVICES, INC.
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:
Provider Other Organization Name Type Code:
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:
1629312822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 N 22ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85016-4701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-955-1000
Provider Business Mailing Address Fax Number:
602-508-4830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
698 E WETMORE RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85705-1751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-955-1000
Provider Business Practice Location Address Fax Number:
602-508-4830
Provider Enumeration Date:
11/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FROMMERT
Authorized Official First Name:
ALLAN
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
623-332-0606

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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