Healthcare Provider Details

I. General information

NPI: 1780306845
Provider Name (Legal Business Name): USV OPTOMETRY OF ARIZONA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 E CACTUS RD
PHOENIX AZ
85032-7702
US

IV. Provider business mailing address

1 HARMON DR
BLACKWOOD NJ
08012-5103
US

V. Phone/Fax

Practice location:
  • Phone: 602-996-6833
  • Fax:
Mailing address:
  • Phone: 856-228-1000
  • 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: RANDI WOERNER
Title or Position: PROFESSIONAL RELATIONS MANAGER
Credential:
Phone: 856-228-1000