Healthcare Provider Details

I. General information

NPI: 1356505960
Provider Name (Legal Business Name): JOSEPH DANIEL GILBUENA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2008
Last Update Date: 02/28/2024
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 EAST MCDOWELL RD STE 301
PHOENIX AZ
85006-2609
US

IV. Provider business mailing address

1425 S ALMA SCHOOL RD STE 103
MESA AZ
85210-2000
US

V. Phone/Fax

Practice location:
  • Phone: 602-222-2234
  • Fax: 866-985-7247
Mailing address:
  • Phone: 480-615-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT3003
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3264ATI
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2039
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: