Healthcare Provider Details

I. General information

NPI: 1851574842
Provider Name (Legal Business Name): NEVZAT CALISKANALP O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 W ARROWHEAD TOWNE CTR
GLENDALE AZ
85308-8616
US

IV. Provider business mailing address

11103 WEST AVE STE 6
SAN ANTONIO TX
78213-1370
US

V. Phone/Fax

Practice location:
  • Phone: 623-486-2020
  • Fax: 623-486-1145
Mailing address:
  • Phone: 210-524-6803
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1594
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: