Healthcare Provider Details

I. General information

NPI: 1275186108
Provider Name (Legal Business Name): CARROT EYE SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 02/06/2023
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S DOBSON RD STE 312
MESA AZ
85202-4752
US

IV. Provider business mailing address

1500 S DOBSON RD STE 312
MESA AZ
85202-4752
US

V. Phone/Fax

Practice location:
  • Phone: 480-561-6000
  • Fax: 480-561-6003
Mailing address:
  • Phone: 480-703-1564
  • Fax: 480-561-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MATTHEW HAMMOND
Title or Position: PRESIDENT
Credential: MD
Phone: 480-703-1564