MEDICARE: SEDONA EYE CARE PC

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	152W00000X	Optometrist	262	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0171820	OTHER	AZ	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1114964939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEDONA EYE CARE PC

Provider Business Mailing Address
First Line	:	95 SOLDIERS PASS ROAD
Second Line	:	STE A1
City	:	SEDONA
State	:	AZ
Zip	:	86336-4781
Country	:	US
Telephone Number	:	928-282-4126
Fax Number	:	928-282-5762

Provider Business Practice Location Address
First Line	:	95 SOLDIERS PASS ROAD
Second Line	:	STE A1
City	:	SEDONA
State	:	AZ
Zip	:	86336-4781
Country	:	US
Telephone Number	:	928-282-4126
Fax Number	:	928-282-5762

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	DR. SERGE W WRIGHT
Credential	:	OD
Telephone Number	:	928-282-4126

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	05/21/2008

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Directions to “SEDONA EYE CARE PC ” Practice Location

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