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NPI Code Detail

MEDICARE: INVISION OPTOMETRY, PLLC

MEDICARE: INVISION OPTOMETRY, PLLC
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
1152W00000XOptometrist1500AZ

General Provider Information

NPI Number : 1124154299
Entity Type Code : Organization
Provider Name (Legal Business Name) : INVISION OPTOMETRY, PLLC
Provider Business Mailing Address
First Line : 17620 W LUNDBERG ST
Second Line :
City : SURPRISE
State : AZ
Zip : 85388-3134
Country : US
Telephone Number : 773-502-7264
Fax Number :
Provider Business Practice Location Address
First Line : 6145 N 35TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-1940
Country : US
Telephone Number : 602-973-6567
Fax Number :
Authorized Official
Title or Position : CHIEF OFFICER
Name : DR. HUSSEIN SHERALI GANGJI
Credential : O.D.
Telephone Number : 773-502-7264
Provider Enumeration Date : 02/26/2007
Last Update Date : 01/31/2008

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