Healthcare Provider Details

I. General information

NPI: 1649506049
Provider Name (Legal Business Name): OPHTHALMIC NURSING CARE OF ARIZONA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 E BELMONT AVE
PHOENIX AZ
85020-4721
US

IV. Provider business mailing address

2202 E BELMONT AVE
PHOENIX AZ
85020-4721
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-9657
  • Fax: 602-285-1518
Mailing address:
  • Phone: 602-279-9657
  • Fax: 602-285-1518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN028029
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163WX1100X
TaxonomyOphthalmic Registered Nurse
License NumberRN028029
License Number StateAZ

VIII. Authorized Official

Name: MR. DAVID M LAMB
Title or Position: VICE PRESIDENT, TREASURER
Credential:
Phone: 602-228-8921