Provider Demographics
NPI:1366621104
Name:IDRS INC
Entity type:Organization
Organization Name:IDRS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CZYZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:623-551-9122
Mailing Address - Street 1:42201 N 41ST DR STE 144
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3802
Mailing Address - Country:US
Mailing Address - Phone:623-551-9122
Mailing Address - Fax:623-551-9120
Practice Address - Street 1:42201 N 41ST DR STE 144
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3802
Practice Address - Country:US
Practice Address - Phone:623-551-9122
Practice Address - Fax:623-551-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1146152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty