Basic Information
| Provider Information | |||||||||
| NPI: | 1457381790 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHWESTERN EYE CENTER LTD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOUTHWESTERN EYE CENTER-SAFFORD OPTICAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2610 E UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852138436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808928400 | ||||||||
| FaxNumber: | 4808929533 | ||||||||
| Practice Location | |||||||||
| Address1: | 2242 W 16TH ST | ||||||||
| Address2: | |||||||||
| City: | SAFFORD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855464081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284280068 | ||||||||
| FaxNumber: | 9284280713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 02/24/2016 | ||||||||
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| AuthorizedOfficialLastName: | BLUTH | ||||||||
| AuthorizedOfficialFirstName: | L. | ||||||||
| AuthorizedOfficialMiddleName: | LOTHAIRE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4808928400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.