Provider Demographics
NPI: | 1669908935 |
---|---|
Name: | VISION CARE LLC |
Entity type: | Organization |
Organization Name: | VISION CARE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OPTOMETRIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | TORRENCE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WATKINS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OD |
Authorized Official - Phone: | 602-358-0223 |
Mailing Address - Street 1: | 2444 W LAS PALMARITAS DR |
Mailing Address - Street 2: | |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85021-4860 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-358-0223 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2444 W LAS PALMARITAS DR |
Practice Address - Street 2: | |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85021-4860 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-358-0223 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | VISION CARE LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2017-05-05 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 1205 | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |