Healthcare Provider Details

I. General information

NPI: 1932553211
Provider Name (Legal Business Name): EYENET TRIAGE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E MISSOURI AVE
PHOENIX AZ
85014-2709
US

IV. Provider business mailing address

1101 E MISSOURI AVE
PHOENIX AZ
85014-2709
US

V. Phone/Fax

Practice location:
  • Phone: 602-222-2221
  • Fax: 602-265-5077
Mailing address:
  • Phone: 602-222-2221
  • Fax: 602-265-5077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PRAVIN U. DUGEL
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 602-222-2221