Healthcare Provider Details

I. General information

NPI: 1689893711
Provider Name (Legal Business Name): OCULOPLASTIC CONSULTANTS OF ARIZONA P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20100 N 51ST AVE SUITE E-570
GLENDALE AZ
85308-5125
US

IV. Provider business mailing address

20100 N 51ST AVE SUITE E-570
GLENDALE AZ
85308-5125
US

V. Phone/Fax

Practice location:
  • Phone: 602-993-9100
  • Fax:
Mailing address:
  • Phone: 602-993-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25627
License Number StateAZ

VIII. Authorized Official

Name: DR. STEVEN CHEN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 602-993-9100