Healthcare Provider Details

I. General information

NPI: 1588005607
Provider Name (Legal Business Name): TAYLOR HUTCHINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2242 W 16TH ST
SAFFORD AZ
85546-4081
US

IV. Provider business mailing address

2610 E UNIVERSITY DR
MESA AZ
85213-8436
US

V. Phone/Fax

Practice location:
  • Phone: 928-428-0068
  • Fax: 928-428-0713
Mailing address:
  • Phone: 480-892-8400
  • Fax: 480-833-6246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1907
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8683123-9934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: