Healthcare Provider Details

I. General information

NPI: 1144744103
Provider Name (Legal Business Name): EYE PRIORITY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 S 46TH ST
PHOENIX AZ
85048-0443
US

IV. Provider business mailing address

15725 S 46TH ST
PHOENIX AZ
85048-0443
US

V. Phone/Fax

Practice location:
  • Phone: 481-893-2300
  • Fax: 480-893-0522
Mailing address:
  • Phone: 481-893-2300
  • Fax: 480-893-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number0862
License Number StateAZ

VIII. Authorized Official

Name: KELLY DE SIMONE
Title or Position: OWNER
Credential: DO
Phone: 480-893-2300