Healthcare Provider Details

I. General information

NPI: 1760796270
Provider Name (Legal Business Name): YAVAPAI ADVANCED VISION CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 05/05/2024
Certification Date: 05/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 WILLOW CREEK RD
PRESCOTT AZ
86301-1154
US

IV. Provider business mailing address

1727 WILLOW CREEK RD
PRESCOTT AZ
86301-1154
US

V. Phone/Fax

Practice location:
  • Phone: 928-717-3259
  • Fax: 928-778-1023
Mailing address:
  • Phone: 928-717-3259
  • Fax: 928-778-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1604
License Number StateAZ

VIII. Authorized Official

Name: DR. MONICA R STOTLER
Title or Position: OWNER
Credential: OD
Phone: 928-717-3259