1871738914 NPI number — CARLOS L GRANDELA O.D. PLC

Table of content: (NPI 1871738914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871738914 NPI number — CARLOS L GRANDELA O.D. PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLOS L GRANDELA O.D. PLC
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:
VIEWFINDER LOW VISION RESOURCE CENTER
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:
1871738914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1830 S ALMA SCHOOL RD STE 131
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:
85210-3088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-924-8755
Provider Business Mailing Address Fax Number:
480-854-1864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1830 S ALMA SCHOOL RD STE 131
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85210-3088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-695-2595
Provider Business Practice Location Address Fax Number:
480-705-4600
Provider Enumeration Date:
12/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRANDELA
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-924-8755

Provider Taxonomy Codes

  • Taxonomy code: 152WL0500X , with the licence number:  1378 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WL0500X , with the licence number: 560 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WL0500X , with the licence number: 526 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WX0102X , with the licence number: 542 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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