MEDICARE: RETINA AND VISION INSTITUTE OF ARIZONA

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1457108565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA AND VISION INSTITUTE OF ARIZONA

Provider Business Mailing Address
First Line	:	2152 S VINEYARD STE 136
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-6882
Country	:	US
Telephone Number	:	480-471-8004
Fax Number	:	480-476-9486

Provider Business Practice Location Address
First Line	:	2152 S VINEYARD STE 136
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-6882
Country	:	US
Telephone Number	:	480-471-8004
Fax Number	:	480-476-9486

Authorized Official
Title or Position	:	OWNER
Name	:	DEREK YOSHIO KUNIMOTO
Credential	:
Telephone Number	:	480-471-8004

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	03/09/2026

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