Healthcare Provider Details

I. General information

NPI: 1073869319
Provider Name (Legal Business Name): JAMIE NICOLE KUHN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 W. UTOPIA RD.
GLENDALE AZ
85308
US

IV. Provider business mailing address

560 E CONTINENTAL RD UNIT 104
GREEN VALLEY AZ
85614-1825
US

V. Phone/Fax

Practice location:
  • Phone: 623-806-7270
  • Fax: 623-806-7210
Mailing address:
  • Phone: 623-806-7270
  • Fax: 623-806-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2737
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1915
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1915
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: