MEDICARE: DESERT VISTA EYEWEAR

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
2	332B00000X	Durable Medical Equipment & Medical Supplies		AZ

General Provider Information

NPI Number	:	1952375099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT VISTA EYEWEAR

Provider Business Mailing Address
First Line	:	2450 E GUADALUPE RD
Second Line	:	STE 107
City	:	GILBERT
State	:	AZ
Zip	:	85234-5116
Country	:	US
Telephone Number	:	480-507-0600
Fax Number	:	480-558-7162

Provider Business Practice Location Address
First Line	:	2450 E GUADALUPE RD
Second Line	:	STE 107
City	:	GILBERT
State	:	AZ
Zip	:	85234-5116
Country	:	US
Telephone Number	:	480-507-0600
Fax Number	:	480-558-7162

Authorized Official
Title or Position	:	OWNER
Name	:	DR. R STUART EASON
Credential	:	M.D.
Telephone Number	:	480-507-0600

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	11/10/2009

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1083688113 — DR. LAWRENCE STEPHEN KAHN M.D.
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Directions to “DESERT VISTA EYEWEAR ” Practice Location

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