Basic Information
| Provider Information | |||||||||
| NPI: | 1487704581 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED OPHTHALMOLOGISTS LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7245 E OSBORN RD | ||||||||
| Address2: | SUITE #4 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809945012 | ||||||||
| FaxNumber: | 4809907364 | ||||||||
| Practice Location | |||||||||
| Address1: | 7245 E OSBORN RD | ||||||||
| Address2: | SUITE #4 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809945012 | ||||||||
| FaxNumber: | 4809907364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | SUITER | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4809945012 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 227117 | 05 | AZ | MEDICAID |