Healthcare Provider Details

I. General information

NPI: 1285809913
Provider Name (Legal Business Name): SONORAN DESERT EYE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 E PECOS RD 1
CHANDLER AZ
85225-6142
US

IV. Provider business mailing address

2211 E PECOS RD 1
CHANDLER AZ
85225-6142
US

V. Phone/Fax

Practice location:
  • Phone: 480-812-2211
  • Fax:
Mailing address:
  • Phone: 480-812-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number945
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY QUARANTA
Title or Position: OFFICE MANAGER
Credential:
Phone: 480-812-2211