Basic Information
| Provider Information | |||||||||
| NPI: | 1780915538 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED OPHTHALMOLOGIST | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ARIZONA EYE SPECIALIST | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7245 E OSBORN RD | ||||||||
| Address2: | #4 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809907361 | ||||||||
| FaxNumber: | 4809907364 | ||||||||
| Practice Location | |||||||||
| Address1: | 13555 W MCDOWELL RD | ||||||||
| Address2: | #102 | ||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232090020 | ||||||||
| FaxNumber: | 4809907364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2010 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | RESHETAR | ||||||||
| AuthorizedOfficialFirstName: | BRANDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4809907271 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.