Basic Information
| Provider Information | |||||||||
| NPI: | 1124357702 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NICOSIA CONSULTING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6501 E GREENWAY PKWY | ||||||||
| Address2: | STE 103-148 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852542065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024691834 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1606 S SIGNAL BUTTE RD | ||||||||
| Address2: | VISION CENTER | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852091482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803589737 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2009 | ||||||||
| LastUpdateDate: | 12/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | NICOSIA | ||||||||
| AuthorizedOfficialFirstName: | DANIELA | ||||||||
| AuthorizedOfficialMiddleName: | MARCELLA | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 6024691834 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.