Healthcare Provider Details

I. General information

NPI: 1265649008
Provider Name (Legal Business Name): DESERT OASIS EYE CARE & OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15256 N 75TH AVE SUITE 380
PEORIA AZ
85381-4760
US

IV. Provider business mailing address

15256 N 75TH AVE SUITE 380
PEORIA AZ
85381-4760
US

V. Phone/Fax

Practice location:
  • Phone: 623-412-8484
  • Fax:
Mailing address:
  • Phone: 623-412-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number848
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number848
License Number StateAZ

VIII. Authorized Official

Name: CHRISTOPHER J PAROT
Title or Position: PRESIDENT
Credential: OD
Phone: 623-412-8484