Healthcare Provider Details

I. General information

NPI: 1215214606
Provider Name (Legal Business Name): JANICE PIERCE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S 63RD ST
MESA AZ
85206-1619
US

IV. Provider business mailing address

3900 E MEXICO AVE STE 102
DENVER CO
80210-3941
US

V. Phone/Fax

Practice location:
  • Phone: 480-641-3937
  • Fax: 480-924-5072
Mailing address:
  • Phone: 720-524-1001
  • Fax: 720-524-1121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2100
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: