Basic Information
| Provider Information | |||||||||
| NPI: | 1154452274 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EYE INSTITUTE OF SOUTHERN ARIZONA | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5632 E 5TH ST | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857112444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207908888 | ||||||||
| FaxNumber: | 5207901427 | ||||||||
| Practice Location | |||||||||
| Address1: | 5632 E 5TH ST | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857112444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207908888 | ||||||||
| FaxNumber: | 5207901427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 10/04/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KUSMAN | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5207908888 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.