Healthcare Provider Details

I. General information

NPI: 1639329386
Provider Name (Legal Business Name): ANTHEM EYE CARE, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 W ANTHEM WAY SUITE B 149
ANTHEM AZ
85086
US

IV. Provider business mailing address

3655 W ANTHEM WAY SUITE B 149
ANTHEM AZ
85086
US

V. Phone/Fax

Practice location:
  • Phone: 623-879-3937
  • Fax:
Mailing address:
  • Phone: 623-879-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE STERN
Title or Position: OWNER
Credential: OD
Phone: 623-879-3937