Healthcare Provider Details

I. General information

NPI: 1992226237
Provider Name (Legal Business Name): ERIC STEVEN BUSHMAN O.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16020 N 35TH AVE STE 2
PHOENIX AZ
85053-3823
US

IV. Provider business mailing address

16020 N 35TH AVE STE 2
PHOENIX AZ
85053-3823
US

V. Phone/Fax

Practice location:
  • Phone: 602-547-3255
  • Fax:
Mailing address:
  • Phone: 602-547-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2181
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: