Healthcare Provider Details

I. General information

NPI: 1720278047
Provider Name (Legal Business Name): ARIZONA INSTITUTE OF EYE SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3192 WILLOW CREEK RD 3192 WILLOW CREEK ROAD
PRESCOTT AZ
86301-6610
US

IV. Provider business mailing address

63 S ROCKFORD DR #220
PHOENIX AZ
85281-4963
US

V. Phone/Fax

Practice location:
  • Phone: 928-778-3950
  • Fax: 928-778-3999
Mailing address:
  • Phone: 602-598-7488
  • Fax: 602-231-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARTHUR D BROOKFIELD
Title or Position: CFO
Credential: MD
Phone: 602-598-7488