Basic Information
| Provider Information | |||||||||
| NPI: | 1265614937 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLACIDO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13624 W CAMINO DEL SOL STE 200 | ||||||||
| Address2: | |||||||||
| City: | SUN CITY WEST | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853753401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235849295 | ||||||||
| FaxNumber: | 6235462399 | ||||||||
| Practice Location | |||||||||
| Address1: | 13624 W CAMINO DEL SOL STE 200 | ||||||||
| Address2: | |||||||||
| City: | SUN CITY WEST | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853753401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235849295 | ||||||||
| FaxNumber: | 6235462399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2007 | ||||||||
| LastUpdateDate: | 12/04/2007 | ||||||||
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| AuthorizedOfficialLastName: | SCHAFFER | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6235849295 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1100X | 22233 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Ophthalmic |
No ID Information.