Healthcare Provider Details

I. General information

NPI: 1265945653
Provider Name (Legal Business Name): NATIONWIDE OPTOMETRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 E CAMELBACK RD
PHOENIX AZ
85016-4202
US

IV. Provider business mailing address

220 N MCKEMY AVE
CHANDLER AZ
85226-2654
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-9135
  • Fax:
Mailing address:
  • Phone: 480-961-1865
  • Fax: 480-893-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARK PELLER
Title or Position: PRESIDENT
Credential: OD
Phone: 480-961-1865