Healthcare Provider Details

I. General information

NPI: 1770653271
Provider Name (Legal Business Name): DAWN SPIRK HEFFELFINGER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W CAMELBACK RD SUITE 1
PHOENIX AZ
85013-2563
US

IV. Provider business mailing address

114 W CAMELBACK RD SUITE 1
PHOENIX AZ
85013-2563
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-4104
  • Fax: 602-241-0687
Mailing address:
  • Phone: 602-264-4104
  • Fax: 602-241-0687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberAZ1108
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: