Healthcare Provider Details

I. General information

NPI: 1306385901
Provider Name (Legal Business Name): URBAN EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N CENTRAL AVE SUITE 115
PHOENIX AZ
85004-4414
US

IV. Provider business mailing address

1 N CENTRAL AVE SUITE 115
PHOENIX AZ
85004-4414
US

V. Phone/Fax

Practice location:
  • Phone: 623-688-1366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2010
License Number StateAZ

VIII. Authorized Official

Name: DR. JASON M KLEPFISZ
Title or Position: OPTOMETRIST/OWNER
Credential: O.D.
Phone: 845-548-1232