Healthcare Provider Details

I. General information

NPI: 1144354515
Provider Name (Legal Business Name): DESERT FAMILY VISION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S CENTRAL AVE
SAFFORD AZ
85546-2692
US

IV. Provider business mailing address

620 S CENTRAL AVE
SAFFORD AZ
85546-2692
US

V. Phone/Fax

Practice location:
  • Phone: 928-428-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: CHARLES FERRIN
Title or Position: MANAGER
Credential:
Phone: 928-428-0500