Basic Information
| Provider Information | |||||||||
| NPI: | 1588005607 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUTCHINS | ||||||||
| FirstName: | TAYLOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2610 E UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852138436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808928400 | ||||||||
| FaxNumber: | 4808336246 | ||||||||
| Practice Location | |||||||||
| Address1: | 2242 W 16TH ST | ||||||||
| Address2: | |||||||||
| City: | SAFFORD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855464081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284280068 | ||||||||
| FaxNumber: | 9284280713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2013 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1907 | AZ | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 8683123-9934 | UT | N | Eye and Vision Services Providers | Optometrist |
No ID Information.