Healthcare Provider Details

I. General information

NPI: 1902445604
Provider Name (Legal Business Name): MVP.VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2019
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 E BOSTON ST STE 101
GILBERT AZ
85295-6246
US

IV. Provider business mailing address

1780 E BOSTON ST STE 101
GILBERT AZ
85295-6246
US

V. Phone/Fax

Practice location:
  • Phone: 480-813-7050
  • Fax: 480-813-3630
Mailing address:
  • Phone: 480-813-7050
  • Fax: 480-813-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TINA COOLEY
Title or Position: OPTOMETRIST
Credential: OD
Phone: 480-813-7050