Basic Information
| Provider Information | |||||||||
| NPI: | 1518208453 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STUART EYE CENTRE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | STUART EYE CENTRE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 421 E IOWA ST | ||||||||
| Address2: | |||||||||
| City: | HOLBROOK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860252770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285246171 | ||||||||
| FaxNumber: | 9285243963 | ||||||||
| Practice Location | |||||||||
| Address1: | 421 E IOWA ST | ||||||||
| Address2: | |||||||||
| City: | HOLBROOK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860252770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285246171 | ||||||||
| FaxNumber: | 9285243963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2013 | ||||||||
| LastUpdateDate: | 03/01/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STUART | ||||||||
| AuthorizedOfficialFirstName: | VIRGIL | ||||||||
| AuthorizedOfficialMiddleName: | CRAIG | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9285246171 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1414 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | 229 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.