MEDICARE: SAMUEL SOESBE, O.D., P.C.

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	804	AZ

General Provider Information

NPI Number	:	1861520017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL SOESBE, O.D., P.C.

Provider Business Mailing Address
First Line	:	1423 S HIGLEY RD
Second Line	:	104
City	:	MESA
State	:	AZ
Zip	:	85206-3429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1423 S HIGLEY RD
Second Line	:	104
City	:	MESA
State	:	AZ
Zip	:	85206-3429
Country	:	US
Telephone Number	:	480-985-0086
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SAMUEL SOESBE
Credential	:	O.D.
Telephone Number	:	480-985-0086

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	08/22/2020

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