Basic Information
| Provider Information | |||||||||
| NPI: | 1285200022 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPTOMETRIC CONSULTING SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2750 S PACIFIC AVE STE D | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853653547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285806356 | ||||||||
| FaxNumber: | 9287838445 | ||||||||
| Practice Location | |||||||||
| Address1: | 2750 S PACIFIC AVE STE D | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853653547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285806356 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2021 | ||||||||
| LastUpdateDate: | 06/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | DETERMAN | ||||||||
| AuthorizedOfficialFirstName: | TOM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9285806356 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.