Healthcare Provider Details

I. General information

NPI: 1336107036
Provider Name (Legal Business Name): RUMMEL EYE CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 WILLOW CREEK RD
PRESCOTT AZ
86301-1607
US

IV. Provider business mailing address

1022 WILLOW CREEK RD SUITE 200
PRESCOTT AZ
86301-1607
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-1341
  • Fax:
Mailing address:
  • Phone: 928-445-1341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC0079
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberOSC0079
License Number StateAZ

VIII. Authorized Official

Name: DIANNE MARIE SCHWARTZ
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 928-445-1341