Healthcare Provider Details

I. General information

NPI: 1063438257
Provider Name (Legal Business Name): MOHAVE EYE CENTERS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 AIRWAY AVE
KINGMAN AZ
86409-3652
US

IV. Provider business mailing address

2110 AIRWAY AVE
KINGMAN AZ
86409-3652
US

V. Phone/Fax

Practice location:
  • Phone: 928-753-2106
  • Fax: 928-753-4283
Mailing address:
  • Phone: 928-753-2106
  • Fax: 928-753-4283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW OCHILTREE
Title or Position: OWNER
Credential: O.D.
Phone: 928-753-2106