Healthcare Provider Details

I. General information

NPI: 1568502813
Provider Name (Legal Business Name): JAMES E. FLORES O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 N MASTICK WAY
NOGALES AZ
85621-1046
US

IV. Provider business mailing address

4800 N 22ND ST
PHOENIX AZ
85016-4701
US

V. Phone/Fax

Practice location:
  • Phone: 520-761-3533
  • Fax: 520-281-1950
Mailing address:
  • Phone: 602-598-7495
  • Fax: 480-892-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number517
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: