Healthcare Provider Details

I. General information

NPI: 1093324956
Provider Name (Legal Business Name): PHOENICIAN EYE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 08/28/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 N BLACK CANYON HWY # C-102
PHOENIX AZ
85053-4055
US

IV. Provider business mailing address

15600 N BLACK CANYON HWY # C-102
PHOENIX AZ
85053-4055
US

V. Phone/Fax

Practice location:
  • Phone: 734-678-1598
  • Fax:
Mailing address:
  • Phone: 734-678-1598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ACHAL JAYESH PATEL
Title or Position: PHYSICIAN
Credential: MD
Phone: 734-678-1598