Healthcare Provider Details

I. General information

NPI: 1225759319
Provider Name (Legal Business Name): PHOENIX OPTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5890 W BELL RD STE 101A
GLENDALE AZ
85308-3884
US

IV. Provider business mailing address

5890 W BELL RD STE 101A
GLENDALE AZ
85308-3884
US

V. Phone/Fax

Practice location:
  • Phone: 561-275-2020
  • Fax: 561-828-8367
Mailing address:
  • Phone: 561-275-2020
  • Fax: 561-828-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL GARZA
Title or Position: MANAGED CARE DIRECTOR
Credential:
Phone: 561-720-6423