Healthcare Provider Details

I. General information

NPI: 1174852388
Provider Name (Legal Business Name): ARIZONA RETINA AND VITREOUS CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 N 16TH ST
PHOENIX AZ
85016-5917
US

IV. Provider business mailing address

3840 N 16TH ST
PHOENIX AZ
85016-5917
US

V. Phone/Fax

Practice location:
  • Phone: 602-232-6066
  • Fax:
Mailing address:
  • Phone: 602-232-6066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number41415
License Number StateAZ

VIII. Authorized Official

Name: DR. RAMIN SCHADLU
Title or Position: OWNER
Credential: M.D.
Phone: 602-232-6066