Basic Information
| Provider Information | |||||||||
| NPI: | 1083911929 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AXIS EYE CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 39148 | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850699148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024396780 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5310 W THUNDERBIRD RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853064706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029422020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2011 | ||||||||
| LastUpdateDate: | 08/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | KAMAL | ||||||||
| AuthorizedOfficialFirstName: | HUMAIRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4803613672 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 30886 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.