Healthcare Provider Details

I. General information

NPI: 1891963203
Provider Name (Legal Business Name): LYNN E PERKINS GLANCY OPTICIAN NCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E OSBORN
PHY AZ
85012
US

IV. Provider business mailing address

300 E OSBORN SUITE 201
PHOENIX AZ
85012
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-3152
  • Fax: 602-234-1552
Mailing address:
  • Phone: 602-277-3152
  • Fax: 602-234-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number613
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: