Healthcare Provider Details

I. General information

NPI: 1043079783
Provider Name (Legal Business Name): ENVISION EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 N TATUM BLVD # A111
PHOENIX AZ
85032-7710
US

IV. Provider business mailing address

12605 N TATUM BLVD # A111
PHOENIX AZ
85032-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-7333
  • Fax: 480-701-8050
Mailing address:
  • Phone: 602-494-7336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. YAMILE ROMAGUERA
Title or Position: PROVIDER / SOLE MEMBER
Credential: OD
Phone: 602-494-7336