Healthcare Provider Details

I. General information

NPI: 1982584199
Provider Name (Legal Business Name): MOLLY BALBIERZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42201 N 41ST DR STE 124-128
ANTHEM AZ
85086-3800
US

IV. Provider business mailing address

2445 E MESCAL ST
PHOENIX AZ
85028-2532
US

V. Phone/Fax

Practice location:
  • Phone: 623-551-9122
  • Fax:
Mailing address:
  • Phone: 716-997-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002895
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: