Healthcare Provider Details

I. General information

NPI: 1063535284
Provider Name (Legal Business Name): BUENA VISTA OPTHALMOLOGISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/16/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E OSBORN RD STE 203
PHOENIX AZ
85012-2396
US

IV. Provider business mailing address

3700 N 24TH ST # 150
PHOENIX AZ
85016-6534
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-8098
  • Fax:
Mailing address:
  • Phone: 602-263-8098
  • Fax: 602-234-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS F MINAS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 602-263-8098