Basic Information
| Provider Information | |||||||||
| NPI: | 1730207739 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JUST FOR EYES LIMITED PARTNERSHIP | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | JUST FOR EYES OPTICAL BOUTIQUE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 10701 W BELL RD | ||||||||
| Address2: | |||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853511074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238764080 | ||||||||
| FaxNumber: | 6239776911 | ||||||||
| Practice Location | |||||||||
| Address1: | 10701 W BELL RD | ||||||||
| Address2: | |||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853511074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238764080 | ||||||||
| FaxNumber: | 6239776911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 06/10/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JUSTO | ||||||||
| AuthorizedOfficialFirstName: | EMILIO | ||||||||
| AuthorizedOfficialMiddleName: | MARTIN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6238764080 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | 18595 | AZ | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.