Healthcare Provider Details

I. General information

NPI: 1326816893
Provider Name (Legal Business Name): ABC OPTICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E MCDOWELL RD STE 301
PHOENIX AZ
85006-2609
US

IV. Provider business mailing address

1010 E MCDOWELL RD STE 301
PHOENIX AZ
85006-2609
US

V. Phone/Fax

Practice location:
  • Phone: 602-222-2234
  • Fax: 602-428-6860
Mailing address:
  • Phone: 602-222-2234
  • Fax: 602-428-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: BRENDAN CASSIDY
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 602-222-2234