Basic Information
| Provider Information | |||||||||
| NPI: | 1477573913 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA PEDIATRIC EYE SPECIALISTS, PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16455 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852116455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808350709 | ||||||||
| FaxNumber: | 4809620523 | ||||||||
| Practice Location | |||||||||
| Address1: | 1520 S DOBSON RD STE 202 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852024726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808350709 | ||||||||
| FaxNumber: | 4809620523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 10/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | VON FLUE | ||||||||
| AuthorizedOfficialFirstName: | DIANE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4806152070 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.