Healthcare Provider Details

I. General information

NPI: 1285789974
Provider Name (Legal Business Name): PEAK VIEW OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 N 22ND ST
PHOENIX AZ
85016-4701
US

IV. Provider business mailing address

1030 N SAN FRANCISCO ST SUITE 130
FLAGSTAFF AZ
86001-3252
US

V. Phone/Fax

Practice location:
  • Phone: 602-955-1000
  • Fax: 602-508-4830
Mailing address:
  • Phone: 928-779-0500
  • Fax: 928-779-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberAZ1128
License Number StateAZ

VIII. Authorized Official

Name: THOMAS J JOHNSON
Title or Position: VICE PRESIDENT
Credential: O.D.
Phone: 928-773-9697