Healthcare Provider Details

I. General information

NPI: 1841521697
Provider Name (Legal Business Name): ASSOCIATED OPHTHALMOLOGIST, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 E BROWN RD STE 10
MESA AZ
85213-4215
US

IV. Provider business mailing address

7245 E OSBORN RD #4
SCOTTSDALE AZ
85251
US

V. Phone/Fax

Practice location:
  • Phone: 480-994-5012
  • Fax: 480-994-9479
Mailing address:
  • Phone: 480-990-7361
  • Fax: 480-990-7364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID SOTO
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 480-994-5012