Healthcare Provider Details

I. General information

NPI: 1457247553
Provider Name (Legal Business Name): AZ LIONS VISION AND HEARING FOUNDATION OF MD21
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 E THOMAS RD # A190
PHOENIX AZ
85016-8299
US

IV. Provider business mailing address

2720 E THOMAS RD # A190
PHOENIX AZ
85016-8299
US

V. Phone/Fax

Practice location:
  • Phone: 602-617-8051
  • Fax: 602-267-7595
Mailing address:
  • Phone: 602-617-8051
  • Fax: 602-267-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONNA JEAN HARRIS
Title or Position: BOARD PRESIDENT
Credential:
Phone: 602-617-8051