MEDICARE: AXIS EYE CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	30886	AZ

General Provider Information

NPI Number	:	1083911929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIS EYE CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 39148
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85069-9148
Country	:	US
Telephone Number	:	602-439-6780
Fax Number	:

Provider Business Practice Location Address
First Line	:	2226 W NORTHERN AVE STE C203
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4929
Country	:	US
Telephone Number	:	602-942-2020
Fax Number	:	602-942-2121

Authorized Official
Title or Position	:	PROVIDER
Name	:	AASIM KAMAL
Credential	:	MD
Telephone Number	:	602-942-2020

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	03/22/2024

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