Healthcare Provider Details

I. General information

NPI: 1013141399
Provider Name (Legal Business Name): OPTICAL EXPRESSIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W MCDOWELL RD
PHOENIX AZ
85003
US

IV. Provider business mailing address

112 W MCDOWELL RD
PHOENIX AZ
85003
US

V. Phone/Fax

Practice location:
  • Phone: 602-254-3169
  • Fax: 602-256-7112
Mailing address:
  • Phone: 602-254-3169
  • Fax: 602-256-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number96003772
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1480
License Number StateAZ

VIII. Authorized Official

Name: LAURIE SHAPIRO
Title or Position: OWNER/MEMBER/PARTNER
Credential:
Phone: 602-254-3169