Healthcare Provider Details

I. General information

NPI: 1316901366
Provider Name (Legal Business Name): TARA HECHT RANSDELL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7727 W DEER VALLEY RD STE E200
PEORIA AZ
85382-7430
US

IV. Provider business mailing address

7727 W DEER VALLEY RD STE E200
PEORIA AZ
85382-7430
US

V. Phone/Fax

Practice location:
  • Phone: 623-376-9070
  • Fax: 623-376-9079
Mailing address:
  • Phone: 623-376-9070
  • Fax: 623-376-9079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1278
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: