1780915538 NPI number — ASSOCIATED OPHTHALMOLOGIST

Table of content: (NPI 1780915538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780915538 NPI number — ASSOCIATED OPHTHALMOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED OPHTHALMOLOGIST
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:
6
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:
1780915538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7245 E OSBORN RD
Provider Second Line Business Mailing Address:
#4
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-990-7361
Provider Business Mailing Address Fax Number:
480-990-7364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13555 W MCDOWELL RD
Provider Second Line Business Practice Location Address:
#102
Provider Business Practice Location Address City Name:
GOODYEAR
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-209-0020
Provider Business Practice Location Address Fax Number:
480-990-7364
Provider Enumeration Date:
01/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RESHETAR
Authorized Official First Name:
BRANDI
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
480-990-7271

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com