Healthcare Provider Details

I. General information

NPI: 1003112798
Provider Name (Legal Business Name): TYRONE JOHN FAVIS II O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E VAN BUREN ST
PHOENIX AZ
85008-6037
US

IV. Provider business mailing address

4333 E BROOKWOOD CT
PHOENIX AZ
85048-8816
US

V. Phone/Fax

Practice location:
  • Phone: 602-559-4606
  • Fax:
Mailing address:
  • Phone: 407-625-1930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT001951
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: