Basic Information
| Provider Information | |||||||||
| NPI: | 1396936845 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASSOCIATED OPTICAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7245 E OSBORN RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809945016 | ||||||||
| FaxNumber: | 4809941948 | ||||||||
| Practice Location | |||||||||
| Address1: | 7245 E OSBORN RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809945016 | ||||||||
| FaxNumber: | 4809941948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2007 | ||||||||
| LastUpdateDate: | 08/08/2007 | ||||||||
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| AuthorizedOfficialLastName: | SUITER | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4809945012 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ASSOCIATED OPHTHALMOLOGISTS | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | 461 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.