Healthcare Provider Details

I. General information

NPI: 1457278384
Provider Name (Legal Business Name): TRAE MEGAFFIN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 W ARROWHEAD CLUBHOUSE DR APT 2087
GLENDALE AZ
85308-8828
US

IV. Provider business mailing address

7400 W ARROWHEAD CLUBHOUSE DR APT 2087
GLENDALE AZ
85308-8828
US

V. Phone/Fax

Practice location:
  • Phone: 785-259-8728
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002965
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: