Healthcare Provider Details

I. General information

NPI: 1083911929
Provider Name (Legal Business Name): AXIS EYE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 W NORTHERN AVE STE C203
PHOENIX AZ
85021-4929
US

IV. Provider business mailing address

PO BOX 39148
PHOENIX AZ
85069-9148
US

V. Phone/Fax

Practice location:
  • Phone: 602-942-2020
  • Fax: 602-942-2121
Mailing address:
  • Phone: 602-439-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number30886
License Number StateAZ

VIII. Authorized Official

Name: AASIM KAMAL
Title or Position: PROVIDER
Credential: MD
Phone: 602-942-2020