Healthcare Provider Details

I. General information

NPI: 1477485381
Provider Name (Legal Business Name): NIZETTE BASOCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 S ARIZONA AVE STE 4
CHANDLER AZ
85286-6510
US

IV. Provider business mailing address

1005 S ARIZONA AVE STE 4
CHANDLER AZ
85286-6510
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-0065
  • Fax:
Mailing address:
  • Phone: 480-214-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002940
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: