Healthcare Provider Details

I. General information

NPI: 1215983135
Provider Name (Legal Business Name): SOUTHWESTERN EYE CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 FLORENCE AVE
KINGMAN AZ
86401-4684
US

IV. Provider business mailing address

63 S ROCKFORD DR STE 220
TEMPE AZ
85288-6226
US

V. Phone/Fax

Practice location:
  • Phone: 928-753-5454
  • Fax: 928-753-7790
Mailing address:
  • Phone: 602-598-7488
  • Fax: 602-231-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARTHUR D BROOKFIELD
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 602-598-7488