Healthcare Provider Details

I. General information

NPI: 1235823394
Provider Name (Legal Business Name): COMPLETE VISION CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1996 E 38TH AVE
APACHE JUNCTION AZ
85119-3780
US

IV. Provider business mailing address

1996 E 38TH AVE
APACHE JUNCTION AZ
85119-3780
US

V. Phone/Fax

Practice location:
  • Phone: 419-953-1139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA LEONARD
Title or Position: OPTOMETRIST
Credential: OD
Phone: 419-953-1139